Male-Type and Prototypal Depression Trajectories for Men Experiencing Mental Health Problems

Growing interest in gender-sensitive assessment of depression in men has seen the development of male-specific screening tools. These measures are yet to be subject to longitudinal latent modelling, which limits evidence about the ability of these tools to detect change, especially relative to established screening scales. In this study, three waves of data were collected from 234 men (38.35 years, SD = 14.09) including 3- and 6-month follow-up. Analyses focused on baseline differences and symptom trajectories for the Patient Health Questionnaire (PHQ; prototypic symptoms) and the Male Depression Risk Scale (MDRS; male-type symptoms). At baseline, men not accessing treatment reported higher MDRS scores relative to treatment-engaged men. There was no group difference for the PHQ. Internal consistency (α, ω) coefficients indicated comparable reliability for both measures across the three waves. Multidomain latent growth modelling, including current treatment engagement as a covariate, reported good model fit (CFI = 0.964, TLI = 0.986, RMSEA = 0.081, SRMR = 0.033) with differential findings for the PHQ and MDRS. Consistent with the baseline between-group analysis, current treatment effects were observed for the MDRS, but not the PHQ. Trajectory modelling for the MDRS indicated that greater severity resulted in slower improvement by 6 months. In contrast, there was no difference in the PHQ rate of change between baseline and 6 months. Findings support the psychometric utility of the MDRS as a male-specific symptom domain measure sensitive to both longitudinal change and potential treatment effects for symptomatic men, in ways not discernible by the PHQ. The MDRS may be a useful adjunctive screening tool for assessing men’s depression.

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Early Psychosis: Diagnosis and Treatment

Current Psychopharmacologye ◽

10.2174/2211556009999200723123322 ◽

2020 ◽

Vol 09 ◽

Author(s):

Nataly S. Beck ◽

Melanie L. Lean ◽

Kate V. Hardy ◽

Jacob S. Ballon

Keyword(s):

United States ◽

Early Identification ◽

Mental Health Problems ◽

The United States ◽

Early Psychosis ◽

Screening Tools ◽

Diagnosis And Treatment ◽

First Episode ◽

Psychotic Episode ◽

First Onset

Background: The typical age of onset for psychotic disorders is concurrent with the typical age of enrollment in higher education. College and graduate students often experience new academic and social demands that may leave them vulnerable to substance use and mental health problems, including the initial onset of a psychotic episode. Objective: To provide a current overview of the guidelines and literature for the diagnosis and treatment of first-onset psychosis with special consideration for the college and graduate student population in the United States. To highlight areas of need and provide recommendations for clinicians who work at educational institutions and their health services, along with general psychiatrists and psychologists who work with post-secondary education populations, to help close the treatment gap. Method: A review of interventions and best practice for the treatment of early psychosis in college students was conducted, informed by the authors’ current experience as clinicians with this population at a United States university. Results: Thorough psychiatric interviews and screening tools can help in the early identification of individuals at clinical high risk for and at first onset of psychosis. Coordinated specialty care services are the gold standard for early psychosis services, including psychotherapy (such as cognitive behavioral therapy and individual resiliency training), as well as support for a student to return to school or work. Individuals experiencing a first episode of psychosis in general respond better to lower doses of antipsychotics and may also experience more adverse effects. Conclusion: Return to a high level of functioning is possible in many cases of first onset of psychosis, and early identification and treatment is essential.

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Plasma NfL levels and longitudinal change rates in C9orf72 and GRN-associated diseases: from tailored references to clinical applications

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2021-326914 ◽

2021 ◽

pp. jnnp-2021-326914

Author(s):

Dario Saracino ◽

Karim Dorgham ◽

Agnès Camuzat ◽

Daisy Rinaldi ◽

Armelle Rametti-Lacroux ◽

...

Keyword(s):

Single Molecule ◽

Light Chain ◽

Rate Of Change ◽

Longitudinal Change ◽

Youden Index ◽

Clinical Genetic ◽

Neurofilament Light Chain ◽

Neurofilament Light ◽

Link Type ◽

Therapeutic Trials

ObjectiveNeurofilament light chain (NfL) is a promising biomarker in genetic frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). We evaluated plasma neurofilament light chain (pNfL) levels in controls, and their longitudinal trajectories in C9orf72 and GRN cohorts from presymptomatic to clinical stages.MethodsWe analysed pNfL using Single Molecule Array (SiMoA) in 668 samples (352 baseline and 316 follow-up) of C9orf72 and GRN patients, presymptomatic carriers (PS) and controls aged between 21 and 83. They were longitudinally evaluated over a period of >2 years, during which four PS became prodromal/symptomatic. Associations between pNfL and clinical–genetic variables, and longitudinal NfL changes, were investigated using generalised and linear mixed-effects models. Optimal cut-offs were determined using the Youden Index.ResultspNfL levels increased with age in controls, from ~5 to~18 pg/mL (p<0.0001), progressing over time (mean annualised rate of change (ARC): +3.9%/year, p<0.0001). Patients displayed higher levels and greater longitudinal progression (ARC: +26.7%, p<0.0001), with gene-specific trajectories. GRN patients had higher levels than C9orf72 (86.21 vs 39.49 pg/mL, p=0.014), and greater progression rates (ARC:+29.3% vs +24.7%; p=0.016). In C9orf72 patients, levels were associated with the phenotype (ALS: 71.76 pg/mL, FTD: 37.16, psychiatric: 15.3; p=0.003) and remarkably lower in slowly progressive patients (24.11, ARC: +2.5%; p=0.05). Mean ARC was +3.2% in PS and +7.3% in prodromal carriers. We proposed gene-specific cut-offs differentiating patients from controls by decades.ConclusionsThis study highlights the importance of gene-specific and age-specific references for clinical and therapeutic trials in genetic FTD/ALS. It supports the usefulness of repeating pNfL measurements and considering ARC as a prognostic marker of disease progression.Trial registration numbersNCT02590276 and NCT04014673.

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Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465818000450 ◽

2018 ◽

Vol 47 (1) ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

Hafrún Kristjánsdóttir ◽

Baldur Heiðar Sigurðsson ◽

Paul Salkovskis ◽

Engilbert Sigurðsson ◽

Magnús Blöndahl Sighvatsson ◽

...

Keyword(s):

Anxiety Disorders ◽

Treatment Effects ◽

Mental Health Problems ◽

Effect Sizes ◽

Low Intensity ◽

Cognitive Behavioural ◽

Wide Range ◽

Common Mental Health Problems ◽

Specific Symptoms ◽

Group Therapies

Background:In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT.Aims:The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment.Method:The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores.Results:Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large.Conclusion:The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.

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Removing the Mask of Average Treatment Effects in Chronic Lyme Disease Research Using Big Data and Subgroup Analysis

Healthcare ◽

10.3390/healthcare6040124 ◽

2018 ◽

Vol 6 (4) ◽

pp. 124 ◽

Cited By ~ 10

Author(s):

Lorraine Johnson ◽

Mira Shapiro ◽

Jennifer Mankoff

Keyword(s):

Lyme Disease ◽

Treatment Effects ◽

Group Analysis ◽

Treatment Protocol ◽

Medical Community ◽

Patient Registries ◽

Average Treatment ◽

Individualized Care ◽

Patient Reported ◽

Average Treatment Effects

Lyme disease is caused by the bacteria borrelia burgdorferi and is spread primarily through the bite of a tick. There is considerable uncertainty in the medical community regarding the best approach to treating patients with Lyme disease who do not respond fully to short-term antibiotic therapy. These patients have persistent Lyme disease symptoms resulting from lack of treatment, under-treatment, or lack of response to their antibiotic treatment protocol. In the past, treatment trials have used small restrictive samples and relied on average treatment effects as their measure of success and produced conflicting results. To provide individualized care, clinicians need information that reflects their patient population. Today, we have the ability to analyze large data bases, including patient registries, that reflect the broader range of patients more typically seen in clinical practice. This allows us to examine treatment variation within the sample and identify groups of patients that are most responsive to treatment. Using patient-reported outcome data from the MyLymeData online patient registry, we show that sub-group analysis techniques can unmask valuable information that is hidden if averages alone are used. In our analysis, this approach revealed treatment effectiveness for up to a third of patients with Lyme disease. This study is important because it can help open the door to more individualized patient care using patient-centered outcomes and real-world evidence.

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Longitudinal change of small-vessel disease-related brain abnormalities

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2015.72 ◽

2015 ◽

Vol 36 (1) ◽

pp. 26-39 ◽

Cited By ~ 37

Author(s):

Reinhold Schmidt ◽

Stephan Seiler ◽

Marisa Loitfelder

Keyword(s):

White Matter ◽

Treatment Effects ◽

Small Vessel Disease ◽

Surrogate Marker ◽

White Matter Lesions ◽

Surrogate Endpoint ◽

Longitudinal Change ◽

Small Vessel ◽

Brain Abnormalities ◽

Vessel Disease

Knowledge about the longitudinal change of cerebral small-vessel disease–related magnetic resonance imaging abnormalities increases our pathophysiologic understanding of cerebral microangiopathy. The change of specific lesion types may also serve as secondary surrogate endpoint in clinical trials. A surrogate endpoint needs to progress fast enough to allow monitoring of treatment effects within a reasonable time period, and change of the brain abnormality needs to be correlated with clinical change. Confluent white matter lesions show fast progression and correlations with cognitive decline. Thus, the change of confluent white matter lesions may be used as a surrogate marker in proof-of-concept trials with small patient numbers needed to show treatment effects on lesion progression. Nonetheless if the expected change in cognitive performance resulting from treatment effects on lesion progression is used as outcome, the sample size needed to show small to moderate treatment effects becomes very large. Lacunes may also fulfill the prerequisites of a surrogate marker, but in the general population the incidence of lacunes over short observational periods is small. For other small-vessel disease–related brain abnormalities including microbleeds and microstructural changes in normal-appearing white matter longitudinal change and correlations with clinical decline is not yet fully determined.

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Cognitive Reserve and Brain Reserve in Prodromal Huntington's Disease

Journal of the International Neuropsychological Society ◽

10.1017/s1355617713000507 ◽

2013 ◽

Vol 19 (7) ◽

pp. 739-750 ◽

Cited By ~ 35

Author(s):

Aaron Bonner-Jackson ◽

Jeffrey D. Long ◽

Holly Westervelt ◽

Geoffrey Tremont ◽

Elizabeth Aylward ◽

...

Keyword(s):

Cognitive Reserve ◽

Morphological Changes ◽

Occupational Status ◽

Disease Onset ◽

Brain Structures ◽

Rate Of Change ◽

Longitudinal Change ◽

Brain Volumes ◽

Cognitive Measure ◽

Intellectual Level

AbstractHuntington disease (HD) is associated with decline in cognition and progressive morphological changes in brain structures. Cognitive reserve may represent a mechanism by which disease-related decline may be delayed or slowed. The current study examined the relationship between cognitive reserve and longitudinal change in cognitive functioning and brain volumes among prodromal (gene expansion-positive) HD individuals. Participants were genetically confirmed individuals with prodromal HD enrolled in the PREDICT-HD study. Cognitive reserve was computed as the composite of performance on a lexical task estimating premorbid intellectual level, occupational status, and years of education. Linear mixed effects regression (LMER) was used to examine longitudinal changes on four cognitive measures and three brain volumes over approximately 6 years. Higher cognitive reserve was significantly associated with a slower rate of change on one cognitive measure (Trail Making Test, Part B) and slower rate of volume loss in two brain structures (caudate, putamen) for those estimated to be closest to motor disease onset. This relationship was not observed among those estimated to be further from motor disease onset. Our findings demonstrate a relationship between cognitive reserve and both a measure of executive functioning and integrity of certain brain structures in prodromal HD individuals. (JINS, 2013, 19, 1–12).

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Prevalence of impairing behavioral health problems in ED patients and association with ED utilization.

Proceedings of IMPRS ◽

10.18060/23544 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Setarah Mohammad Nader ◽

Paul Musey Jr., MD, MS, FACEP

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Behavioral Health ◽

Emergency Departments ◽

Mental Health Problems ◽

Severe Depression ◽

Health Problems ◽

Screening Tools ◽

Convenience Sample ◽

Severe Anxiety

Background and Hypothesis: It has been observed that patients with poor mental health are relatively frequent users of the Emergency Departments (ED). The objective of this study is to evaluate the prevalence of numerous behavioral health domains (depression, anxiety, PTSD, substance abuse, and suicidality) in patients presenting to the Emergency Department and the association of each of these domains with ED utilization. Experimental Design or Project Methods: This prospective study seeks to enroll a convenience sample of 1000 Englishspeaking adults presenting to IU Health Methodist and Eskenazi Emergency Departments without psychiatric chief-complaints. Patients were assessed for behavioral health problems using the CAT-MHTM, PHQ-8 and GAD-7 screening tools, which were administered via tablet device. Additionally, data on disposition medical history, discharge diagnoses, and ED utilization in the 12 months before and after enrollment from electronic medical records and data from the Indiana Network for Patient Care (INPC) will be reviewed. Results: Over the course of five weeks, 375 patients have been enrolled. Of those 59.4% were female with an overall mean age of 46.1 (SD ± 16.4); 52.9% were white and 39.8% black/African American. Among enrollees 42.2% screened positive for depression, 29.7% for anxiety, and 1.3% for suicidal ideation. Patients who screened positive for depression were predominately females (76.1% vs 23.9%), those who screened positive for anxiety were also predominately females (71.6% vs. 28.4%). However, 3 out of the 5 (60%) patients that screened positive for suicidal ideation were males. The preliminary analysis of GAD-7 showed of those enrolled 215 (57.5%) had no anxiety, 157 (42%) had mild-severe anxiety. PHQ-8 scores showed 194 (51.9%) had no depression, 178 (47.5%) had mild-severe depression. Similarly, CAT-MH results showed 216 (57.8%) had no depression, 158 (42.2%) had mild-severe depression, while 263 (70.3%) had no anxiety and 111 (29.7%) had mild-severe anxiety. Full data analysis including comparative analysis of the CAT-MH with PHQ-8 and GAD-7 scores will take place after 1000 patients have been enrolled and data has been received from the INPC. Conclusion and Potential Impact: In our sample, almost half of patients that visit the ED have screened positive for mental health problems. We believe that early identification and appropriate referral may reduce inappropriate ED utilization.

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“Breaking the silence”: Sexual victimisation in an old age psychiatry patient population in Flanders

10.1101/2021.02.03.21251063 ◽

2021 ◽

Author(s):

Anne Nobels ◽

Ines Keygnaert ◽

Egon Robert ◽

Christophe Vandeviver ◽

An Haekens ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Old Age ◽

Health Care Professionals ◽

Mental Health Problems ◽

Physical Contact ◽

Screening Tools ◽

Face To Face ◽

Old Age Psychiatry

AbstractBackgroundSexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging.MethodsBetween July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape.OutcomesIn 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before.InterpretationSexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.

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