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Diagnostic and Statistical Manual of Mental Disorders: DSM-V

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... Consensus was reached on including all the DSM-5 main criteria for PTSD (e.g., avoidance symptoms, mood symptoms). 43 However, consensus was not reached on some of the sub-criteria, as these were regarded as non-specific and could also be symptoms of BPSD or related to ageing (e.g., difficulty concentrating, physical activity after trauma reminder; see Table 3). Fifteen of the 24 sub-criteria from DSM-5 reached consensus and were included in the new instrument. ...
... The DSM-5 shows that these were the main essential criteria in cognitively impaired patients. 43 This can be explained by case reports in the literature that indicate that criterion C (avoidance Table 2. Agreement ratings regarding the elements. symptoms) were rarely reported. ...
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Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and 6 international experts in the field of PTSD and dementia care or research. The aim was to reach consensus in 3 rounds on the added value, form, content, and application for developing such an instrument. The first round confirmed the need for a new diagnostic tool for research and clinical practice. Consensus was reached on 23 statements regarding the support base and 19 related to content of the instrument. In the third round, opinions on several conceptual problems were gathered. Based on the experts' opinions, a draft version of an instrument, the TRAuma and DEmentia-interview (TRADE-interview), was developed. Clinical and research implications of this new measure are discussed.
... Autism spectrum disorder (hereafter, autism) is a neurodevelopmental condition characterised by difficulties with reciprocal social communication, restricted interests, repetitive behaviours and sensory anomalies [1]. In addition to these core features, it is recognised that up to 70% of autistic individuals have at least one co-occurring psychiatric diagnosis [2], with up to 50% having multiple additional diagnoses [3]. ...
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Autistic people experience high rates of co-occurring psychiatric diagnoses. Current prevalence estimates vary considerably due to an over-reliance on clinical cohorts and the longitudinal stability of diagnoses from childhood into adolescence is poorly understood. This study aims to provide prevalence rates of co-occurring DSM-5 psychiatric diagnosis for autistic adolescence and investigate, for the first time, the stability of diagnoses from childhood. Using a longitudinal stratified sample of autistic youth ( N = 77; 13–17 years; 60% male), selected from a larger community-derived sample of those with pre-existing autism diagnoses ( N = 277) weighted prevalence estimates of emotional (anxiety, depression), behavioural (oppositional and conduct disorders) and ADHD diagnoses were calculated based on semi-structured psychiatric interview. Prediction of adolescent psychiatric diagnosis based on childhood diagnostic status, sex, childhood IQ (both assessed at age 4–10 years) was tested. Emotional and behavioural disorders in adolescence were particularly prevalent, and significantly predicted by childhood disorder status. Attention-deficit/hyperactivity-disorder (ADHD) was prevalent but not predicted by childhood ADHD diagnosis. Neither sex nor childhood IQ predicted diagnostic outcomes. Autistic youth have high levels of co-occurring psychiatric conditions, which are broadly persistent across childhood and adolescence. Emotional disorders are particularly prevalent and remain persistent from childhood to adolescence. Greater diagnostic variability was found for ADHD with more adolescents moving across diagnostic thresholds.
... 3 Anxiety symptoms have been shown to impact social activities, work, and home life. 4 The impact of COVID-19 has potentially left many individuals without proper psychological treatment. Possible anxietyrelated circumstances, such as fear of crowds or fear of infection, and limited psychological services may also contribute towards individuals Soliva et. ...
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PURPOSE: The purpose of this study was to examine the effects that an acute bout of online yoga has on anxiety. The secondary purpose was to compare the anxiolytic effects of this study to the effect size reported for the effects of acute in-person yoga (1). METHODS: Eligible participants were randomly assigned to a 30-minute, prerecorded Zoom session of either yoga practice or yoga information. Prior to and following completing the recording, participants completed an online survey assessing anxiety and mood. An effect size (SMD) was calculated and compared to the effect size reported in a meta-analysis (1). RESULTS: Statistically significant group X time interactions were found for anxiety outcomes (intensity, frequency, total) (p<.026) and for POMS tension, fatigue, depression, esteem-related, vigor, and total mood disturbance scores, p<.041. Yoga participants reported a greater reduction in total anxiety and total mood disturbance scores compared to information participants. The SMD anxiety scores in this study was .54 (95% CI, .051-1.034), which is comparable to the effect size previously reported (1) which was .55 (95% CI, .29-.79). CONCLUSION: Acute online yoga was found to reduce anxiety. When compared to in person yoga, online yoga appears to have similar anxiolytic effects.
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Background Understanding how pandemics differentially impact on the socio-protective and psychological outcomes of males and females is important to develop more equitable public health policies. We assessed whether males and females differed on measures of major depression and generalized anxiety during the COVID-19 the pandemic, and if so, which sociodemographic, pandemic, and psychological variables may affect sex differences in depression and anxiety. Methods Participants were a nationally representative sample of Irish adults (N = 1,032) assessed between April 30th to May 19th, 2020, during Ireland’s first COVID-19 nationwide quarantine. Participants completed self-report measures of anxiety (GAD-7) and depression (PHQ-9), as well as 23 sociodemographic pandemic-related, and psychological variables. Sex differences on measures of depression and anxiety were assessed using binary logistic regression analysis and differences in sociodemographic, pandemic, and psychological variables assessed using chi-square tests of independence and independent samples t-tests. Results Females were significantly more likely than males to screen positive for major depressive disorder (30.6% vs. 20.7%; χ² (1) = 13.26, p < .001, OR = 1.69 [95% CI = 1.27, 2.25]), and generalised anxiety disorder (23.3% vs. 14.4%; χ² (1) = 13.42, p < .001, OR = 1.81 [95% CI = 1.31, 2.49]). When adjusted for all other sex-varying covariates however, sex was no longer significantly associated with screening positive for depression (AOR = 0.80, 95% CI = 0.51, 1.25) or GAD (AOR = 0.97, 95% CI = 0.60, 1.57). Conclusion Observed sex-differences in depression and anxiety during the COVID-19 pandemic in the Republic of Ireland are best explained by psychosocial factors of COVID-19 related anxiety, trait neuroticism, lower sleep quality, higher levels of loneliness, greater somatic problems, and, in the case of depression, increases in childcaring responsibilities and lower trait consciousnesses. Implications of these findings for public health policy and interventions are discussed.
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Introduction The aim of this systematic review was to synthesize the literature on the correlates and risk factors of anxiety among adults with ID. Methods Following the PRISMA guidelines, a systematic search of peer-reviewed literature was conducted across six major electronic databases. From an initial screening of 844 records, 13 studies were included for full-text review. Factors associated with anxiety were categorized utilizing the biopsychosocial model. Methodological quality was evaluated. Results Correlates of anxiety were identified at all levels of the biopsychosocial model, including psychological or psychiatric diagnoses, level of ID, gender, chronic health conditions, stressful life events, and social interactions. Modifiable correlates were discussed as potential targets for designing anxiety interventions for adults with ID. Conclusion Despite the increased recognition of the mental health needs of individuals with ID in recent years, this review highlighted a dearth of research investigating the risk factors of anxiety among this population.
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This study aimed to investigate whether and how avoidant personality disorder symptoms are related to cardiovascular reactivity to stress tasks with different levels of cognitive demands. The revised Chinese edition of the avoidant personality disorder subscale of Personality Diagnosed Questionnaire-4+ (PDQ-4+) was administered to 222 undergraduate students randomly assigned to psychological stress tasks (i.e., mental arithmetic tasks) with low, moderate, or high cognitive demands (manipulated by task difficulty), during which their physiological data were continuously collected. Results showed that avoidant personality disorder symptoms and cognitive demands of tasks interactively predicted systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity. In specific, avoidant personality disorder symptoms were not associated with SBP reactivity under the low- and moderate-demand conditions and DBP reactivity under the low-demand condition but were associated with blunted SBP reactivity under the high-demand condition and blunted DBP reactivity under the moderate- and high-demand conditions. These findings indicate that the association between avoidant personality disorder symptoms and cardiovascular reactivity to psychological stress is contingent on the cognitive demands of tasks, which have potential implications for physical health.
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Although developmental reading disorders (developmental dyslexia) have been mainly associated with auditory-phonological deficits, recent longitudinal and training studies have shown a possible causal role of visuo-attentional skills in reading acquisition. Indeed, visuo-attentional mechanisms could be involved in the orthographic processing of the letter string and the graphemic parsing that precede the grapheme-to-phoneme mapping. Here, we used a simple paper-and-pencil task composed of three labyrinths to measure visuo-spatial attention in a large sample of primary school children (n = 398). In comparison to visual search tasks requiring visual working memory, our labyrinth task mainly measures distributed and focused visuo-spatial attention, also controlling for sensorimotor learning. Compared to typical readers (n = 340), children with reading difficulties (n = 58) showed clear visuo-spatial attention impairments that appear not linked to motor coordination and procedural learning skills implicated in this paper and pencil task. Since visual attention is dysfunctional in about 40% of the children with reading difficulties, an efficient reading remediation program should integrate both auditory-phonological and visuo-attentional interventions.
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هدفت الدراسة إلى التعرف على فعالية برنامج عن بعد قائم على فنيات تحليل السلوك التطبيقي لإكساب الأمهات الأميات أساليب التعامل مع سلوكيات أطفالهن من ذوي اضطراب طيف التوحد. ولتحقيق ذلك استخدمت الدراسة المنهج الشبه تجريبي المتمثل في تصميم المجموعة الواحدة. وتمثلت عيِّنة الدراسة من (9) أمهات أميات لأطفال من ذوي اضطراب طيف التوحد المتواجدات بمركز التوحد بمنطقة الطائف، وعليه تألفت أدوات الدراسة من مقياس مستوى امتلاك الأمهات لفنيات تعديل السلوك إعداد هيثم الحيارى (2018)، وتصميم برنامج عن بعد قائم على فنيات تحليل السلوك التطبيقي من إعداد الباحثة. وتوصلت النتائج إلى وجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب زيادة السلوك المرغوب لصالح القياس البعدي، ووجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب خفض السلوك غير المرغوب لصالح القياس البعدي، وجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب تشكيل السلوك الجديد لصالح القياس البعدي.
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Research regarding the accuracy of co‐morbid psychiatric diagnoses in individuals with intellectual and developmental disabilities (IDD) is sparse. Yet correct diagnostic assignment is vital so that effective and appropriate treatment can be implemented, especially for the large numbers of individuals requiring expensive and restrictive behavioural health crisis services. A retrospective review of de‐identified data from multidisciplinary specialty team assessments completed for 50 individuals with ID (IntellectualDisability) with and without ASD and unresolved behavioural health challenges was conducted. The accuracy and reliability of the psychiatric diagnoses upon referral were compared with the diagnoses after the comprehensive team evaluation, and within‐individual diagnostic agreement was calculated. The agreement between the Mood and Anxiety Semi‐Structured interview tool (MASS) and the full team evaluation was also calculated. The influence of demographic and clinical characteristics on diagnostic agreement was explored. The most common chief complaints upon referral were aggression to others and self‐injurious behaviour. Individuals were taking a median of six medications (interquartile range: 5 to 7); 80% were taking an antipsychotic medication. The most common medical conditions were constipation (70%) and gastroesophageal reflux disease (52%). Measures of interrater reliability of the referral diagnoses with the team assessment were below 0.5 (kappa range: −0.04 to 0.39), with the exception of ruling out dementia (kappa = 0.85). The interrater reliability estimates for the MASS evaluations for depression and anxiety were higher (kappa = 0.69 and 0.64) and reflected higher sensitivity and PPV. The odds of any referral diagnosis being confirmed by team evaluation were low: 0.25 (range: 0 to 0.67). The level of diagnostic agreement for each patient was not significantly attributable to demographic or clinical characteristics, although effect sizes indicate a possible positive relationship to age and the number of prescribed psychotropic medications at referral. Individuals in the current study had serious psychiatric and behavioural problems despite psychiatric care in their communities. The majority of psychiatric diagnoses provided upon referral were not supported by the multidisciplinary specialty team's assessment. In addition to possible diagnostic inaccuracy, the group in the study suffered from multiple medical co‐morbidities and were exposed to polypharmacy. Results emphasise the importance of multidisciplinary evaluation by clinicians with expertise in neurodevelopmental disabilities when people with ID with and without ASD have complex behavioural health needs that are unresponsive to usual care. In addition, based on agreement with the full team evaluation, the MASS shows promise as an assessment tool, especially with regards to identifying anxiety and depression.
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Social anxiety is a symptom widely prevalent among young adults, and when present in excess, can lead to maladaptive patterns of social behavior. Recent approaches that incorporate brain functional radiomic features and machine learning have shown potential for predicting certain phenotypes or disorders from functional magnetic resonance images. In this study, we aimed to predict the level of social anxiety in young adult participants by training machine learning models with resting-state brain functional radiomic features including the regional homogeneity, fractional amplitude of low-frequency fluctuation, fractional resting-state physiological fluctuation amplitude, and degree centrality. Among the machine learning models, the XGBoost model achieved the best performance with balanced accuracy of 77.7% and F1 score of 0.815. Analysis of input feature importance demonstrated that the orbitofrontal cortex and the degree centrality were most relevant to predicting the level of social anxiety among the input brain regions and the input type of radiomic features, respectively. These results suggest potential validity for predicting social anxiety with machine learning of the resting-state brain functional radiomic features and provide further understanding of the neural basis of the symptom.
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Objective Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic CBT treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes. Method 200 children and adolescents (M age 9.5, S.D. 2.2; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview, parent, and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at post-treatment and six-month follow-up. Results The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either post-treatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%)(although the latter approached significance, p=.08). Nor did they differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task. Conclusion Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes.
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In this mini-review, we discuss the fundamentals of using technology in mental health diagnosis and tracking. We highlight those principles using two clinical concepts: (1) cravings and relapse in the context of addictive disorders and (2) anhedonia in the context of depression. This manuscript is useful for both clinicians wanting to understand the scope of technology use in psychiatry and for computer scientists and engineers wishing to assess psychiatric frameworks useful for diagnosis and treatment. The increase in smartphone ownership and internet connectivity, as well as the accelerated development of wearable devices, have made the observation and analysis of human behavior patterns possible. This has, in turn, paved the way to understand mental health conditions better. These technologies have immense potential in facilitating the diagnosis and tracking of mental health conditions; they also allow the implementation of existing behavioral treatments in new contexts (e.g., remotely, online, and in rural/underserved areas), and the possibility to develop new treatments based on new understanding of behavior patterns. The path to understand how to best use technology in mental health includes the need to match interdisciplinary frameworks from engineering/computer sciences and psychiatry. Thus, we start our review by introducing bio-behavioral sensing, the types of information available, and what behavioral patterns they may reflect and be related to in psychiatric diagnostic frameworks. This information is linked to the use of functional imaging, highlighting how imaging modalities can be considered “ground truth” for mental health/psychiatric dimensions, given the heterogeneity of clinical presentations, and the difficulty of determining what symptom corresponds to what disease. We then discuss how mental health/psychiatric dimensions overlap, yet differ from, psychiatric diagnoses. Using two clinical examples, we highlight the potential agreement areas in assessment/management of anhedonia and cravings. These two dimensions were chosen because of their link to two very prevalent diseases worldwide: depression and addiction. Anhedonia is a core symptom of depression, which is one of the leading causes of disability worldwide. Cravings, the urge to use a substance or perform an action (e.g., shopping, internet), is the leading step before relapse. Lastly, through the manuscript, we discuss potential mental health dimensions.
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Objective This study examined past year attempts to reduce or quit gambling among people who gamble generally and those with gambling problems specifically. Methods Regular gamblers recruited from an online panel ( N = 10,054) completed a survey of gambling, mental health and substance use comorbidity and attempts to reduce or quit gambling. The sample was weighted to match the gambling and demographic profile for the same subsample (i.e., past month gamblers) in a recent Canadian national survey. Results 5.7% reported that they tried to cutback or stop gambling in the past year. As predicted, individuals making a change attempt had greater levels of problem gambling severity and were more likely to have a gambling problem. Of individuals with problem gambling, 59.8% made a change attempt. Of those, 90.2% indicated that they did this primarily on their own, and 7.7% accessed formal or informal treatment. Most people attempting self- change indicated that this was a personal preference (55%) but about a third reported feeling too ashamed to seek help. Over a third (31%) reported that their attempt was successful. Of the small group of people accessing treatment, 39% described it as helpful. Conclusions Whereas gambling treatment-seeking rates are low, rates of self-change attempts are high. The public health challenge is to promote self-change efforts among people beginning to experience gambling problems, facilitate success at self-change by providing accessible support for use of successful strategies, and provide seamless bridges to a range of other treatments when desired or required.
Article
Children with ADHD show deficits in executive functioning, especially the ability to inhibit inadequate responses, and deficits in motivational processes due to dopaminergic dysfunctions. There is evidence that rewards can foster inhibition in children with ADHD. However, most studies examined a wide age range of children above 7 years of age, so almost nothing is known about inhibition and reward effects on inhibition in younger children. The primary goals of the present study were a) to examine response inhibition in young children with ADHD in a relatively narrow age range (5–8 years) in comparison to children without ADHD b) to investigate whether performance in an inhibition task can be fostered by rewards in this young age group. For this purpose, children with ADHD (n = 20) and control children (n = 20) were recruited from schools as well as pediatric, psychiatric, and psychological practices in North Rhine-Westphalia, Germany. Children conducted a Go/NoGo task under a non-rewarded and a rewarded condition. Our findings demonstrate a generally decreased response inhibition in ADHD as compared to control children. Rewards led to improvements in response inhibition in both groups of children. However, in contrast to control children whose ability to inhibit increased with practice in both conditions, children with ADHD inhibition decreased over the course of the non-rewarded condition but was raised by the prospect of a reward at the start of the reward condition. Thus, it seems that already at this young age, German children without ADHD are better able to keep their inhibition ability up over time than children with ADHD.
Article
A research protocol was developed to test a theoretical model regarding impulsivity in borderline personality (BP) disorder. It was hypothesized that the impact of identity disturbance of individuals with BP features on their response-inhibition functions could be explained by the disposition of their self-concept to increase the intensity of negative emotions. Participants with different levels of BP features were assigned to a self-description condition (N = 29) that had the potential to manipulate the identity coherence, or a control condition (N = 27) prior to a response inhibition task with high and low arousal emotional stimuli. We also explored the relationship between participants’ self-description and their performance on the inhibition task. The results showed a significant interaction between condition, level of BP features, valence, and stimulus intensity on commission errors. Post-hoc analysis did not reveal significant differences. In addition, a moderate correlation was found between a lesser differentiated description of the self and a higher mean of errors of commission. This preliminary study highlights the relevance of studying the relationship between the self-concept and inhibition regarding borderline impulsivity. The findings should be replicated with a larger sample and with individuals who meet the diagnostic criteria.
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Objective: Posttraumatic stress disorder (PTSD) is associated with high comorbidity rates across the full range of psychiatric disorders. However, little is known about how psychiatric comorbidity manifests among people with PTSD, particularly with regard to concurrent diagnoses. Method: Latent class analysis (LCA) was used to characterize discrete classes of PTSD comorbidity using past year DSM-5 diagnostic standards among a large nationally representative epidemiologic sample of U.S. adults. Follow-up analyses compared participant characteristics across latent classes. Results: The LCA was best characterized by five classes: low comorbidity, distress-fear, distress-externalizing, mania-fear-externalizing, and mania-externalizing. Excluding the low comorbidity class, proportions of borderline and schizotypal personality disorder were high across classes. Conclusion: Participant characteristics across classes of past year PTSD comorbidity are explored through the lens of case conceptualization and treatment planning utility.
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Children with autism spectrum disorder (ASD) not only have communication and social difficulties, but also exhibit poor balance and motor control ability, which frequently affect daily activities. Effective balance and motor control rely on the integration of somatosensory, visual, and vestibular inputs. Although reports of balance dysfunction in ASD have been documented, comprehensive studies of balance and vestibular function in children with ASD are scarce. In this study, we retrospectively reviewed 36 pediatric patients diagnosed with ASD who underwent balance/vestibular laboratory testing in our speciality clinic. Results from sensory organization test (SOT) or modified clinical test for sensory integration of balance (mCTSIB) found that out of 15 patients, 80% had abnormal findings. Of the children who successfully completed each vestibular test, abnormal responses were observed in 12 (80%) sensory organization tests, 5 (24%) vestibular evoked myogenic potential (VEMP), 22 (66%) videonystagmography (VNG), and 11 (32%) sinusoidal rotary chair tests. These results indicate that balance and vestibular testing may be of diagnostic value for clinicians and providers as an aid in early detection, intervention, and the development of appropriate management and therapies for this patient population. Increased awareness of this topic is warranted to promote better clinical management of this special group of patients and improve their quality of life.
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Purpose Children exposed to adversity (e.g., chronic poverty, traumatic events, and maltreatment) are at increased risk for performing below age expectations on norm-referenced language assessments, but it is unknown whether the risk is higher for specific language impairment (SLI). This exploratory study investigated whether adversity exposure is associated with reduced grammar knowledge and SLI. Method The syntax subtest of the Diagnostic Evaluation of Language Variation–Norm-Referenced (DELV-NR) assessment was administered to 30 school-age children with known histories of adversity exposure. Their primary caregiver also completed a comprehensive adversity exposure measure, which captured adverse event type, frequency, chronicity, and severity. Analyses included t tests, correlations, Mann–Whitney U tests, and chi-square. Results Overall, the sample performed below age expectations on the DELV-NR Syntax subtest, and a higher percentage of participants (20%) met diagnostic criteria for SLI than expected. The SLI and typical language (TL) groups did not significantly differ in adversity dosage, frequency, chronicity, or severity; however, participants in the SLI group were 1.46 times more likely to have experienced physical trauma than the participants in the TL group. Conclusions Children with known histories of adversity exposure presented with grammatical deficits and SLI more often than expected based on the DELV-NR normative sample; however, features of the adverse event did not associate with SLI status except for exposure to physical trauma (e.g., physical abuse and victimization). Future research is needed to investigate the prevalence and potential causal pathways of SLI in this population. Supplemental Material https://doi.org/10.23641/asha.20483706
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Researchers who wish to engage with survivors of conflict and violence face a range of complex ethical issues – including psychological dimensions of research – often with few resources or little support. This article draws on the author’s reflections as both a trauma therapist and field researcher and bridges the fields of mental health and conflict studies to explore two questions: 1) How can a researcher reduce the possibility of retraumatizing or causing psychological harm to study participants? 2) How can she diminish the possibility of being psychologically harmed herself? The author argues that a researcher must have a foundational understanding of psychological trauma, cultivate an awareness of the differences between research and healing, sharpen her interviewing skills, and identify means of co-producing knowledge to reduce the possibility for retraumatization. Researchers can prepare themselves for the psychological impacts of research by increasing self-awareness, engaging a variety of social and professional supports, and limiting exposure to traumatic material. The author argues for institutions to increase their responsibility for the well-being of researchers. This article begins to sketch the contours of ‘trauma-informed methodologies’ and contributes to the broader discussion of research ethics of fieldwork and conflict.
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Purpose of Review The history of pharmacotherapy to treat sexual desire disorders is fraught with political debate that pits clinical psychologists, sexologists, and sociologists against the sexual medicine and uro-gyn communities. This review highlights events that led to this rift and how it played out politically to influence decisions made by regulatory bodies like the US Food and Drug Administration during and after hearings to consider approving testosterone, flibanserin, and bremelanotide, for the treatment of sexual desire disorders in women. Recent Findings The current climate for further development of pharmacotherapies is questionable due to a lack of proper marketing and a campaign of misinformation about currently approved drugs as weak, dangerous, and/or unnecessary. Summary Pharmacotherapies work, and their promise as adjuncts to sex therapy for HSDD will give women far more choice in the kind of treatments that fit their needs. Such treatments may well have efficacy in men and trans persons with HSDD.
Article
Young people with neurodevelopmental disorders, such as attention‐deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.
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Trichotillomania is an often debilitating psychiatric condition characterized by recurrent pulling out of one’s own hair, leading to hair loss and marked functional impairment. Although discussed in the medical literature for over a century, trichotillomania was not officially included as a mental disorder in DSM until 1987, when it was classified as an impulse control disorder not elsewhere classified in DSMIII-R. In DSM-5, trichotillomania is included in the chapter on obsessive-compulsive and related disorders, along with obsessive-compulsive disorder, excoriation disorder, body dysmorphic disorder, and hoarding disorder.
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Numbers of adolescents experiencing gambling related harm are increasing. Teachers spend a significant amount of time with students and their attitudes can make an impact on engagement in high-risk behavior. However, teachers’ awareness of, and attitudes towards adolescent gambling are under-researched; this study aimed to address this gap. 157 UK schoolteachers completed an online survey assessing their perceptions of adolescent gambling. Cochran’s-Q tests of association and regression analyses revealed that teachers perceived adolescent gambling as significantly less serious than other high-risk behaviors. Teachers also reported having significantly less frequent conversations about gambling and were less confident addressing gambling issues than other high-risk behaviors. Arguments are made for increased teacher training around problematic youth gambling. Such a strategy would be a prerequisite for the development and implementation of targeted prevention from harms.
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Research characterizing the neuronal substrate of anxiety has implicated different brain areas, including the medial septal nucleus (m-SEPT). Previous reports indicated a role of dopamine and nitric oxide (NO) in anxiety-related behaviors. In this study, the extracellular single-unit recording was performed from the m-SEPT in adult male albino Wistar rats. Baseline activity was recorded for 5 min, and the post-injection recording was performed for another 5 min after the microinjection of each drug. The results showed that (1) both D1- and D2-like receptor agonists (SKF-38393 and quinpirole) enhanced the firing rate of m-SEPT neurons; (2) both D1- and D2-like antagonists (SCH-23390 and sulpiride) attenuated the firing rate of m-SEPT neurons; (3) l-arginine (NO precursor) increased the firing rate of m-SEPT neurons, but a non-specific NOS inhibitor, l-NAME, elicited no significant alterations; (4) the non-specific NOS inhibitor reversed the enhanced firing rate produced by SKF-38393 and quinpirole; (5) neither of the dopaminergic antagonists changed the enhanced activity resulted from the application of the NO precursor. These results contribute to our understanding of the complex neurotransmitter interactions in the m-SEPT and showed that both dopaminergic and NO neurotransmission are involved in the modulation of the firing rate of neurons in the m-SEPT.
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Background Long-term care facilities (LCFs) in South Korea have limited knowledge of and capability to care for patients with delirium. They also often lack an electronic medical record system. These barriers hinder systematic approaches to delirium monitoring and intervention. Therefore, this study aims to develop a web-based app for delirium prevention in LCFs and analyse its feasibility and usability. Methods The app was developed based on the validity of the AI prediction model algorithm. A total of 173 participants were selected from LCFs to participate in a study to determine the predictive risk factors for delerium. The app was developed in five phases: (1) the identification of risk factors and preventive intervention strategies from a review of evidence-based literature, (2) the iterative design of the app and components of delirium prevention, (3) the development of a delirium prediction algorithm and cloud platform, (4) a pilot test and validation conducted with 33 patients living in a LCF, and (5) an evaluation of the usability and feasibility of the app, completed by nurses (Main users). Results A web-based app was developed to predict high risk of delirium and apply preventive interventions accordingly. Moreover, its validity, usability, and feasibility were confirmed after app development. By employing machine learning, the app can predict the degree of delirium risk and issue a warning alarm. Therefore, it can be used to support clinical decision-making, help initiate the assessment of delirium, and assist in applying preventive interventions. Conclusions This web-based app is evidence-based and can be easily mobilised to support care for patients with delirium in LCFs. This app can improve the recognition of delirium and predict the degree of delirium risk, thereby helping develop initiatives for delirium prevention and providing interventions. Moreover, this app can be extended to predict various risk factors of LCF and apply preventive interventions. Its use can ultimately improve patient safety and quality of care.
Article
El presente artículo es producto de una investigación la cual se ubica en el paradigma positivista bajo el enfoque cuantitativo, enmarcada en un diseño nivel descriptivo Su propósito estuvo orientado en analizar el rol de los padres en el desarrollo socio afectivo de niños de 2 a 3 años con autismo que asisten a la atención psicología en el Instituto Nacional de la Niñez y la Familia, (INFA) Portoviejo –Ecuador. En el proceso indagatorio, participó una muestra constituida por 5 parejas de padres a quienes se les aplico una entrevista tomada de un instrumento estandarizado creado por Stone, W.L., & Hogan, K.L. (1993), el mismo se le hicieron adaptaciones para cumplir el propósito del estudio manteniéndose las dimensiones: Relaciones sociales, relaciones afectivas, interacción y comunicación, todo ello con respecto al niño autista, en tanto al rol de los padres se contemplaron la autoridad, las relaciones afectivas, la sobreprotección, el respeto, y la comunicación. Los resultados dan a conocer que los roles más evidentes es el del padre sobreprotector y el de relaciones afectivas lo cual permite concluir que es fundamental entender la situación del niño, y no intentar que actúen de forma norma, al lograr concebir esto es demostrativo que se esta la posición de aceptarlo y respetarlo tal cual como él es, y pueden fijar la atención necesaria para su desarrollo social y afectivo
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Objective Pediatric patients can be significantly impacted emotionally by exposure to acute trauma which may negatively impact long-term functioning and lead to an increase in overall distress. This study reports on the incidence of acute stress disorder among pediatric trauma patients in a hospital setting in the southeastern region of the USA. Methods Pediatric patient mental health assessments were conducted using the Childhood Stress Disorders Checklist- Short Form (CSDC-SF) as part of a new integrated behavioral health standard of care within the Trauma Services Division of a level 1 pediatric hospital. Mental health consultations occurred at bedside on inpatient hospital admission into trauma services, or at the outpatient hospital clinic after discharge for injuries treated in the emergency department. Results Associations among type of trauma, child age, and sex were explored in a sample of 617 children (58.9% male) aged 2–18 years ( M age =10.27). The sample was primarily ethnic minorities (56.1% black/African-American, 5% Hispanic/Latinx). Fifteen per cent or more of trauma reports were for burns (26%), motor vehicle accident (22.7%), and recreational sports or leisure activity-related injury (17.5%). Sixty-four per cent of children scored ≥1 on the CSDC-SF, indicating symptoms consistent with acute stress disorder. Higher scores were associated with female sex, age, and injury type. Level of evidence Level IV study provides evidence of the link between traumatic injury and mental health symptoms in a pediatric population. Findings highlight the critical need for mental health screening and provision of integrated mental health counseling services at time of acute pediatric trauma.
Chapter
Depression does not always equal major depressive disorder. Depression is a nonspecific symptom that can result from a number of different causes, and not all of them are psychiatric illnesses—or even pathologic at all. Clinically significant depression in the real world is also usually multifactorial. This can have important implications for both prognosis and treatment. When making a diagnosis of a depressive disorder, it is therefore important to be able to appreciate the differences in how these disorders most commonly present. This chapter will describe the most important and common depressive disorders and explain how to recognize them in your patients.KeywordsDiagnosisMajor depressive disorderAdjustment disorderDysthymiaBipolar disorderCyclothymiaSeasonal affective disorderPremenstrual dysphoric disorder
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Resumen Introducción La enfermedad de Huntington (EH) es un trastorno neurodegenerativo y hereditario. A partir del diagnóstico predictivo se han descrito características clínicas incipientes en la fase prodrómica, y varios estudios han reportado aumento de síntomas psiquiátricos en portadores de la mutación causante de la EH, sin síntomas motores, en esta fase. Objetivo Identificar malestar psicológico en portadores de la mutación causante de la EH sin síntomas motores, mediante el Symptom Checklist 90 (SCL-90), y correlacionar con la carga y cercanía de la enfermedad. Método Una muestra de 175 participantes de un Programa de Diagnóstico Predictivo de EH (PDP-EH) se dividió en portadores PEH (39,4%) y no portadores NPEH (61,6%) de la mutación causante de EH. Mediante fórmulas matemáticas se obtuvo la carga de enfermedad y cercanía a la etapa manifiesta en el grupo PEH y se correlacionó con los resultados del inventario SCL-90-R. Resultados Al comparar los resultados obtenidos en el SCL-90-R de los PEH y NPEH, la diferencia se observa en el índice de malestar por síntomas positivos, donde los portadores obtienen mayor puntuación promedio. Las correlaciones entre carga de enfermedad y síntomas psicológicos se dan en los dominios: obsesiones y compulsiones, sensibilidad interpersonal, hostilidad, índice de severidad global e índice de malestar somático positivo. Se observa una correlación baja entre la carga de enfermedad y las puntuaciones obtenidas en el malestar psicológico. Conclusiones En general encontramos que el grupo PEH obtiene un puntaje mayor en las dimensiones evaluadas con el SCL-90, muestran relación con la carga y diferencias por la cercanía de la enfermedad. Puntajes mayores en las dimensiones del SCL-90-R en portadores del gen para la EH pueden sugerir un hallazgo temprano de la sintomatología psicológica en la enfermedad.
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Preschoolers commonly experience symptoms of ADHD and disruptive behavior problems. Behavioral parent management training (PMT) is an evidence-based intervention for addressing both ADHD and disruptive behaviors in this population; however, many PMT programs are burdensome in length and have limited data regarding long-term effectiveness for ADHD specific outcomes. This study examined outcomes up to 1 year following completion of a brief behavioral intervention (M = 6.51 sessions) for preschoolers. Participants were children aged 2–6 years with clinically significant disruptive behaviors and their parents. Results demonstrated significant improvements in parent-reported child hyperactivity and inattention from pre-to-post intervention, with sustained improvement at 6 months and 1 year post intervention. Teacher-reported hyperactivity and inattention also showed significant improvements from pre-to-post intervention, which were maintained across time points. These results were also found among a subset of participants with clinically significant ADHD symptoms at baseline. This study highlights the long-term effectiveness of a brief PMT program to address symptoms of ADHD and disruptive behaviors in preschoolers. Findings support the recommendation to offer PMT as a first-line intervention for preschoolers with ADHD symptoms to reduce the need for early intervention with stimulant medication and address comorbid disruptive behaviors.
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Background Children with Attention Deficit Hyperactivity Disorder (ADHD) face deficits in working memory capacity that often persist into adulthood. In healthy peers, exercise targeting motor skill acquisition benefits visuospatial working memory, but its potential to reduce ADHD-related deficits remains unclear. We investigated the effect of a judo training program targeting motor skills on behavioral and neurocognitive indices of working memory capacity in children with ADHD. Methods Children with ADHD aged 8 to 12 years (N=57) were randomly allocated to a judo training group and a wait-list control group. The training program encompassed 120 min of judo per week over three months. Before and after the intervention period, patients completed a bilateral Change Detection task with low and high memory load conditions and the Movement Assessment Battery for Children-2 (MABC-2). The contralateral delay activity (CDA) elicited by the cognitive task was recorded using electroencephalography. Results Compared to the control group, the judo training group showed a higher K-score on the Change Detection task and an increased negativity of the CDA on the high load condition following the intervention, when pretest scores (and confounders) were accounted for. In contrast, no group differences were found for MABC-2 score. Conclusion In children with ADHD, judo training may complement pharmacological treatment by increasing the effectiveness of working memory maintenance processes. On a behavioral level, this improvement is accompanied with an increased capacity to store visuospatial information.
Article
Purpose Informal caregivers play an important role in chronic disease management but their experience is often neglected. The objective of this study was to explore the content validity of the Zarit Burden Interview (ZBI) in caregivers of individuals with COPD in Canada and Portugal. Materials and methods Cognitive debriefing interviews were conducted with informal caregivers of individuals with moderate to very severe COPD. Participants completed the ZBI and verbalised their thinking process to assess the adequacy of the questionnaire’s content and instructions. Content validity was assessed using deductive content analysis of interviews and descriptive statistics of questionnaire responses. Results Nine caregivers from Canada (age = 67 ± 8 years) and 13 from Portugal (age = 69 ± 7 years) participated. For Canadian caregivers, 3/22 items were not understood, and 8/22 items were not relevant to at least 1/3 of them. For Portuguese caregivers, 1/22 items were not understood, and 20/22 items were not relevant to at least 1/3 of them. The distribution of response choices was approximately symmetrical for 17/22 items in the Canadian sample. The response option “no/never” was selected by at least 75% of Portuguese participants for 18/22 items. Conclusions The instrument was well understood by caregivers of people with COPD, but its relevance is uncertain. • IMPLICATIONS FOR REHABILITATION • Informal caregivers provide essential care for people living with disability and chronic disease, but their experience is often neglected. • The Zarit Burden Interview assesses caregiver burden but has not been validated in caregivers of people with chronic obstructive pulmonary disease. • In its current form, the Zarit Burden Interview does not adequately represent the experience of COPD caregivers. • We recommend selecting tools that assess caregiver burden that have been validated in the caregiver population of interest.
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Intrusive memories are a core feature of posttraumatic stress disorder and have transdiagnostic relevance across mental disorders. Establishing flexible methods to monitor intrusions, including patterns and characteristics, is a key challenge. A daily diary has been developed in experimental settings to provide symptom count data, without the need for retrospective self‐report over extended time periods (e.g., 1 week, 1 month). We conducted an exploratory, pre‐registered data synthesis investigating convergence between the diary and questionnaire measures of intrusive symptoms long used in clinical practice (Impact of Event Scale, IES, and revised version, IES‐R, Intrusion subscale). Utilising datasets using the daily diary from 11 studies (4 real‐world trauma studies, seven analogue trauma studies; total N = 578), we found significant positive associations between the diary and IES/IES‐R Intrusion subscale. Exploratory analyses indicated that the magnitude of this association was stronger for the IES (vs. the IES‐R), and in individuals with real‐world (vs. analogue) trauma. This study provides first evidence of convergent validity of a daily diary for monitoring intrusions with a widely used questionnaire. A diary may be a more flexible methodology to obtain information about intrusions (frequency, characteristics, triggers, content), relative to questionnaires which rely on retrospective reporting of symptoms over extended timeframes. We discuss potential benefits of daily monitoring of intrusions in clinical and research contexts.
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Background and Objectives: Better understanding of predictors of opioid abstinence among patients with opioid use disorder (OUD) may help to inform interventions and personalize treatment plans. This analysis examined patient characteristics associated with opioid abstinence in the X:BOT (Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment) trial. Methods: This post-hoc analysis examined factors associated with past-month opioid abstinence at the 36-week follow-up visit among participants in the X:BOT study. 428 participants (75% of original sample) attended the visit at 36 weeks. Logistic regression models were used to estimate the probability of opioid abstinence across various baseline sociodemographics, clinical characteristics, and treatment variables. Results: Of the 428 participants, 143 (33%) reported abstinence from non-prescribed opioids at the 36-week follow-up. Participants were more likely to be opioid abstinent if randomized to XR-NTX (compared to BUP-NX), were on XR-NTX at week 36 (compared to those off OUD pharmacotherapy), successfully inducted onto either study medication, had longer time on study medication, reported a greater number of abstinent weeks, or had longer time to relapse during the 24-week treatment trial. Participants were less likely to be abstinent if Hispanic, had a severe baseline Hamilton Depression Rating (HAM-D) score, or had baseline sedative use. Conclusions: A substantial proportion of participants was available at follow-up (75%), was on OUD pharmacotherapy (53%), and reported past-month opioid abstinence (33%) at 36 weeks. A minority of patients off medication for OUD reported abstinence and additional research is needed exploring patient characteristics that may be associated with successful treatment outcomes.
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Physical exercise and healthy diet have a positive effect on health. However, the pathological dimension of both behaviors, namely exercise dependence and orthorexia nervosa, can lead to negative results. So far, literature on these behaviors in the context of high-intensity sports is limited. The present study aims for investigating exercise dependence and orthorexia nervosa in a sample of Crossfit athletes, as well as examining the mediating role of perfectionism in their manifestation.The sample consisted of 110 people who attended Crossfit programs and 131 active gym members. The Exercise Dependence Scale was used to assess exercise dependence, the ORTO-15 to assess orthorexic behavior and the Almost Perfect Scale to evaluate perfectionism.19.8% of crossfitters and 3.8% of gym members were at risk for exercise dependence. 11.7% of participants in the Crossfit group and 10% of participants in the control group had orthorexic symptoms. An association was found between the scores on the two behaviors. In addition, the dimension of perfectionism high standards predicted obligatory exercise and orthorexia nervosa, while the dimension of discrepancy predicted only exercise dependence.The study suggests that exercise dependence is more evident in Crossfit compared to gym athletes and may be accompanied by orthorexic symptoms. Orthorexia nervosa is a noticeable phenomenon in the population of active exercisers. Perfectionism is a risk factor for obligatory exercise and orthorexia. A more demanding selection of target populations is encouraged in order to better understand exercise dependence, orthorexia nervosa and their personality background.
Article
Autistic traits—subclinical forms of characteristics associated with autism spectrum disorders—are associated with poor social interactions and high risks for mental health disorders. We hypothesized that altered sensitivity to social rejection is an important contributor to psychological distress observed among individuals with high autistic traits. Experiment 1 adopted a social‐judgment task and compared behavioral and neural activity in response to social rejection between participants exhibiting either high or low autistic traits (HAT and LAT, respectively). Rejection‐induced hurt feelings, P3 amplitudes, and θ‐oscillation magnitudes were greater in the HAT group than in the LAT group. Mediation analysis indicated that autistic traits heighten rejection‐induced social pain through increasing frontal‐midline θ‐oscillations. Responses to nonsocial feedback in the age‐judgment task were comparable, confirming that the between‐group differences were specific to social negative feedback. Experiment 2 assessed the association between autistic traits, rejection sensitivity, and psychological distress among randomly recruited participants. Results showed that autistic traits affected depressive/anxious symptomatology partially through heightened rejection sensitivity. Therefore, autistic traits heighten sensitivity to rejection‐induced social pain that leads to psychological distress. This finding will help facilitate the development of strategies for coping with social pain and improving mental health for individuals with high autistic traits. Autistic traits are associated with poor social interactions and high risks for mental health disorders. We adopted a social‐judgment task and compared behavioral and neural activity in response to social rejection between participants exhibiting either high or low autistic traits. Mediation analysis indicated that autistic traits heighten rejection‐induced social pain through increasing frontal‐midline θ‐oscillations.
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Long interspersed nucleotide element-1 (LINE-1) and Alu elements are retrotransposons whose abilities cause abnormal gene expression and genomic instability. Several studies have focused on DNA methylation profiling of gene regions, but the locus-specific methylation of LINE-1 and Alu elements has not been identified in autism spectrum disorder (ASD). Here we interrogated locus- and family-specific methylation profiles of LINE-1 and Alu elements in ASD whole blood using publicly-available Illumina Infinium 450 K methylation datasets from heterogeneous ASD and ASD variants ( Chromodomain Helicase DNA-binding 8 ( CHD8 ) and 16p11.2del). Total DNA methylation of repetitive elements were notably hypomethylated exclusively in ASD with CHD8 variants. Methylation alteration in a family-specific manner including L1P, L1H, HAL, AluJ , and AluS families were observed in the heterogeneous ASD and ASD with CHD8 variants. Moreover, LINE-1 and Alu methylation within target genes is inversely related to the expression level in each ASD variant. The DNA methylation signatures of the LINE-1 and Alu elements in ASD whole blood, as well as their associations with the expression of ASD-related genes, have been identified. If confirmed in future larger studies, these findings may contribute to the identification of epigenomic biomarkers of ASD.
Article
Background Postoperative delirium (POD) is a common surgical complication in elderly patients. As frailty is a relatively novel concept, its clinical significance for POD has seldom been examined. This study aimed to investigate the association between frailty and POD in aged cancer patients undergoing elective abdominal surgery in Taiwan. Material and Methods We prospectively enrolled 345 consecutive patients aged ≥65 years with newly diagnosed cancer who underwent elective abdominal surgery between 2016 and 2018. Frailty assessment was performed using the Comprehensive Geriatric Assessment (CGA). POD was assessed daily using the Confusion Assessment Method from postoperative day 1 until discharge. Patients were allocated into fit and frail groups. Results POD occurred in 19 (5.5%) of 345 patients. POD incidence was 1.6%, 3.1%, 4.8%, 11.5%, and 10.0% in patients with 0, 1, 2, 3, and 4+ frail conditions, respectively, which presented a positive linear correlation among patients with an increased number of frail conditions and POD incidence. Based on CGA, 159 (46.1%) and 186 (53.9%) patients were allocated to fit and frail groups, respectively. POD incidence was 2.5% and 8.1% for the fit and frail groups, respectively. Frailty status was an independent risk factor for POD occurrence in multivariate analysis. Conclusions Our study identified frailty as an independent risk factor for POD in aged Taiwanese cancer patients undergoing elective abdominal surgery. Given the high prevalence of frailty among older cancer patients, preoperative assessment is important to identify high risk of POD and to improve the quality of postoperative care. Keywords: cancer, surgery, delirium, frailty.
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The article presents the results of validation of the Ukrainian ver- sion of the Binge Eating Scale (BES), the psychometric properties of which have not yet been tested among the Ukrainian-speaking population. The BES is a questionnaire de- signed to identify and diagnose in- dividuals suffering from Binge-eating disorder (BED). The aim of the work was to check the psychometric properties of the Ukrainian version of BES, to es- tablish the factor structure, internal consistency and constructive validity in the sample of Ukrainian youth. A cross-sectional study of 87 par- ticipants was conducted: students from different higher education in- stitutions who could read and write in the Ukrainian language. To char- acterize the criterion of validity, the BES was compared with the data of the clinical criteria for BED on DSM- 5, which in this study is considered the gold standard for the diagnosis of BED. The Ukrainian version of BES dem- onstrated a standardized Cronbach’s alpha of 0.885, showing good internal consistency close to high (0.9). The split half size was 0.899, indi- cating a very high split half. The corre- lation between the halves of the test was 0.766720035, which indicates a fairly high reliability in terms of in- ternal consistency. Factor analysis showed a two- factor structure. This explained only 46.2 % of the variance. The ROC analysis found that the re- sulting area under the curve (AUC) was 0.811 (95 % CI: 0.713; 0.887), indicating good model quality. The results of our study confirm the psychometric reli- ability of the BES, high design and criterion validity. Thus, the Ukrainian version of BES has psychometric char- acteristics close to the original.
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The contrast avoidance model (CAM) proposes that individuals suffering from generalized anxiety disorder (GAD) fear abrupt shifts from a positive to a negative emotional state (negative emotional contrast). We posited that greater fear of uncontrollable emotional experiences and intolerance of uncertainty could have an indirect effect on the relationship between avoidance of negative emotional contrasts and GAD. As an exploratory objective, we investigated whether fear of a specific emotion (anger, anxiety, depression and positive emotion) is implicated in the mediation. A sample of 233 adults completed measures of the study variables. Avoidance of negative emotional contrast was significantly related to GAD symptom severity. General fear of emotions and intolerance of uncertainty each mediated the relationship between the tendency to avoid emotional contrast and GAD symptoms. However, when the mediation analysis was repeated with fear of specific emotions, none of the feared emotions was a significant mediator, and neither was intolerance of uncertainty. The results suggest that the relation between avoidance of emotional contrasts and GAD symptoms is explained by a greater fear of emotional reactions and intolerance of uncertainty. However, when fear of a specific emotion was taken into account, none of these emotional experiences seems to drive this relationship, which is consistent with the CAM that does not posit a fear of a specific emotion, but rather the fear of an unexpected negative emotional contrasts.
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Objective The aim of this systematic review (SR) was to gather all available epidemiological evidence on former participation in any type of sport, at a professional and varsity level, as a potential risk factor for neurodegenerative diseases (NDs) and neurocognitive disorders (NCDs). Design Systematic searches were performed on PubMed, the Cochrane databases, and the ISI Web of Knowledge databases. Included studies were assessed using the NOS checklist. Eligibility criteria for selecting studies All epidemiological studies reporting data on the possible association between a clinical diagnosis of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND), dementia or mild cognitive impairment (MCI), Parkinson’s disease (PD), chronic traumatic encephalopathy (CTE) at any stage and with any clinical pattern and the former participation in any types of sport at a varsity and professional level were included. Results Data from the 17 included studies showed a higher frequency of NDs and NCDs in former soccer and American football players. Updating the previous SR confirmed a higher frequency of ALS/MND in former soccer players. Data reported a significantly higher risk of dementia/AD in former soccer players, and of MCI in former American football players. Results also showed a significantly higher risk of PD in former soccer and American football players, and a significantly higher risk of CTE in former boxers and American football players. Summary/conclusions This SR confirmed a higher risk of NDs and NCDs in former professional/varsity athletes. However, the pathological mechanisms underlying this association remain unclear, and further high-quality studies should be performed to clarify whether the association could be sport specific.
Article
Binge-eating disorder (BED) is associated with a greater risk for cardiac problems and co-occurring health conditions. Resting-state measures of high-frequency heart rate variability (HF-HRV), which is a physiological proxy of self-regulatory neural functioning, may aid understanding of health risks. We systematically reviewed and meta-analyzed the literature on HF-HRV in individuals with BED and without BED. Six studies were reviewed in the qualitative synthesis, and five studies assessing HRV in individuals with BED ( n = 153) and without BED ( n = 124) were included in the meta-analysis. A non-significant effect size (Hedges’ g = .08, SE = 0.36, 95% CI [−0.62, 0.78]; z = 0.23, p = .82) was found, suggesting no difference in HF-HRV between groups. Age, BMI, and BMI-matched control status were not significant covariates. Synthesizing the five studies with available data, we found no difference in resting-state HF-HRV between individuals with and without BED. There was high heterogeneity in the sample, suggesting potential moderators. We discuss potential mechanisms, methodological and demographic confounds, and future directions for study.
Article
Purpose Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD. Design/methodology/approach This is a conceptual paper that includes a case vignette. Findings A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals. Research limitations/implications It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group. Practical implications Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group. Originality/value There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
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Objectives: This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women with depression. Design and setting: The Australian Genetics of Depression Study is an online case cohort study of the aetiology of depression. For a range of variables, women with depression who report significant perinatal depressive symptoms were compared with women with lifetime depression who did not experience perinatal symptoms. Participants: In a large sample of parous women with major depressive disorder (n=7182), we identified two subgroups of PND cases with and without prior depression history (n=2261; n=878, respectively). Primary and secondary outcome measures: The primary outcome measure was a positive screen for PND on the lifetime version of the Edinburgh Postnatal Depression Scale. Descriptive measures reported lifetime prevalence, timing of onset and duration of PND symptoms. There were no secondary outcome measures. Results: The prevalence of PND among parous women was 70%. The majority of women reported at least one perinatal episode with symptoms both antenatally and postnatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.15 per additional depression episode, 95% CI 1.13 to 1.17, p<0.001), non-European ancestry (OR 1.5, 95% CI 1.0 to 2.1, p=0.03), severe nausea during pregnancy (OR 1.3, 95% CI 1.1 to 1.6, p=0.006) and emotional abuse (OR 1.4, 95% CI 1.1 to 1.7, p=0.005). Conclusions: The majority of parous women with lifetime depression in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.
Article
Objective This research aimed to assess the effectiveness of combination therapy with amantadine and clonidine against clonidine alone on subjective opioid withdrawal symptoms in patients treated with buprenorphine. Methods and Materials Patients were recruited from outpatient addiction treatment centers for this double-blind, randomized control trial. They were divided into two groups randomly assigned to receive either clonidine (0.15–0.3 mg/day) or clonidine with amantadine (100–200 mg/day). We assessed withdrawal symptoms with the Subjective Opiate Withdrawal Scale (SOWS) on the first day of admission and 3, 7, 14, and 21 days afterward. Results Forty-three patients completed the trial in each group. The impact of adding-on amantadine on the mean SOWS compared to control was significant (p < .001) at any time of the study period. However, there were no significant differences in mean SOWS within groups during follow-up (p > .05). Also, there were no significant differences in mean SOWS between the two groups during follow-up time (day 3rd, 7th, 14th, and 21st) (p > .05). Conclusion Amantadine and clonidine combined treatment would result in fewer opioid withdrawal symptoms than clonidine alone, with a decrease commencing on the third day.
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