Associations between air pollution and psychiatric symptoms in the normative aging study

Background: Environmental risk factors for psychiatric health are poorly identified. We examined the association between air pollution and psychiatric symptoms, which are often precursors to the development of psychiatric disorders. Methods: This study included 570 participants in the US Veterans Administration (VA) Normative Aging Study and 1,114 visits (defined as an onsite follow-up at the VA with physical examination and questionnaires) from 2000-2014 with information on the Brief Symptom Inventory (BSI) to assess their psychiatric symptom levels. Differences in the three BSI global measures (Global Severity Index – GSI, Positive Symptom Distress Index – PSDI and Positive Symptom Total - PST) were reported per interquartile (IQR) increase of residential address-specific air pollutants levels (fine particulate matter – PM2.5, ozone - O3, nitrogen dioxide – NO2) at averages of 1 week, 4 weeks, 8 weeks and 1 year prior to the visit using generalized additive mixed effects models. We also evaluated modification by neighborhood factors. Results: On average, among the NAS sample (average age, 72.4 yrs. (standard deviation: 6.7 yrs.)), an IQR increase in 1- and 4- week averages of NO2 before visit was associated with a PSDI T score (indicator for psychiatric symptom intensity) increase of 1.60 (95% Confidence Interval (CI): 0.31, 2.89), 1.71 (95% CI: 0.18, 3.23), respectively. Similarly, for each IQR increase in 1- and 4-week averages of ozone before visit, PSDI T-score increased by 1.66 (95% CI: 0.68, 2.65), and 1.36 (95% CI: 0.23, 2.49), respectively. Stronger associations were observed for ozone and PSDI in low house value and low household income areas. No associations were found for PM2.5. Conclusions: Exposure to gaseous air pollutants was associated with higher intensity of psychiatric symptoms among a cohort of older men, particularly in communities with lower socio-economic or housing conditions.

The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders

Background The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood. Objectives Examine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes. Design Observational, self-report, single time-point online assessment. Participants A total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic. Main Outcomes and Measures CROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis. Results CROS total scores correlated significantly with all four psychiatric symptom domains (R’s = .42–.53), likelihood of leaving one’s current occupation (R = .18), and trouble doing usual work (R = .28), all p’s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties. Conclusions and Relevance These results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

COMPLEX TOURETTE'S DISORDER WITH OCD TREATED WITH LITHIUM

Tourette’s disorder is a complex neuropsychiatric condition, and consequently treatment options are also different.. A complicated case of Tourette’s disorder was seen at our clinic. Treatment with standard medication was not successful. A trial of lithium seemed to provide significant cessation of both neurological as well as psychiatric symptom

A service evaluation of short-term mentalisation based treatment for personality disorder

Background People with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment. Aims We aimed to evaluate mental health, client satisfaction and psychological functioning outcomes before and after a 10-week group MBT programme as part of a stepped-care out-patient personality disorder service. Method We examined routinely collected pre–post treatment outcomes from 176 individuals (73% female) aged 20–63 years, attending a dedicated out-patient personality disorder service, who completed MBT treatment. Participants completed assessments examining mentalising capacity, client satisfaction, emotional reactivity, psychiatric symptom distress and social functioning. Results Post-MBT outcomes suggested increased mentalising capacity (mean difference 5.1, 95% CI 3.4–6.8, P < 0.001) and increased client satisfaction with care (mean difference 4.3, 95% CI 3.3–5.2, P < 0.001). Post-MBT emotional reactivity (mean difference −6.3, 95% CI −8.4 to −4.3, P < 0.001), psychiatric symptom distress (mean difference −5.2, 95% CI −6.8 to −3.7, P < 0.001) and impaired social functioning (mean difference −0.7, 95% CI −1.2 to −0.3, P = 0.002) were significantly lower than pre-treatment. Improved mentalising capacity predicted improvements in emotional reactivity (β = −0.56, P < 0.001) and social functioning (β = −0.35, P < 0.001). Conclusions Short-term MBT as a low-intensity treatment for personality disorder was associated with positive pre–post treatment changes in social and psychological functioning. MBT as deployed in this out-patient service expands access to personality disorder treatment.

Inattentive responding can induce spurious associations between task behavior and symptom measures

A common research design in the field of computational psychiatry involves leveraging the power of online participant recruitment to assess correlations between behavior in cognitive tasks and the self-reported severity of psychiatric symptoms in large, diverse samples. Although large online samples have many advantages for psychiatric research, some potential pitfalls of this research design are not widely understood. Here we detail circumstances in which entirely spurious correlations may arise between task behavior and symptom severity as a result of inadequate screening of careless or low-effort responding on psychiatric symptom surveys. Specifically, since many psychiatric symptom surveys have asymmetric ground-truth score distributions in the general population, participants who respond carelessly on these surveys will show apparently elevated symptom levels. If these participants are similarly careless in their task performance, and are not excluded from analysis, this may result in a spurious association between greater symptom scores and worse behavioral task performance. Here, we demonstrate exactly this pattern of results in N = 386 participants recruited online to complete a self-report symptom battery and a short reversal-learning choice task. We show that many behavior-symptom correlations are entirely abolished when participants flagged for careless responding on surveys are excluded from analysis. We also show that exclusion based on task performance alone is not sufficient to prevent these spurious correlations. Of note, we demonstrate that false-positive rates for these spurious correlations increase with sample size, contrary to common assumptions. We offer guidance on how researchers using this general experimental design can guard against this issue in future research; in particular, we recommend the adoption of screening methods for self-report measures that are currently uncommon in this field.