Mismatch Negativity and P3a Impairment through Different Phases of Schizophrenia and Their Association with Real-Life Functioning

Impairment in functioning since the onset of psychosis and further deterioration over time is a key aspect of subjects with schizophrenia (SCZ). Mismatch negativity (MMN) and P3a, indices of early attention processing that are often impaired in schizophrenia, might represent optimal electrophysiological candidate biomarkers of illness progression and poor outcome. However, contrasting findings are reported about the relationships between MMN-P3a and functioning. The study aimed to investigate in SCZ the influence of illness duration on MMN-P3a and the relationship of MMN-P3a with functioning. Pitch (p) and duration (d) MMN-P3a were investigated in 117 SCZ and 61 healthy controls (HCs). SCZ were divided into four illness duration groups: ≤ 5, 6 to 13, 14 to 18, and 19 to 32 years. p-MMN and d-MMN amplitude was reduced in SCZ compared to HCs, independently from illness duration, psychopathology, and neurocognitive deficits. p-MMN reduction was associated with lower “Work skills”. The p-P3a amplitude was reduced in the SCZ group with longest illness duration compared to HCs. No relationship between P3a and functioning was found. Our results suggested that MMN amplitude reduction might represent a biomarker of poor functioning in SCZ.

Interplay among positive and negative symptoms, neurocognition, social cognition, and functional outcome in clinically stable patients with schizophrenia: a network analysis

Background: Schizophrenia has a broad range of interrelated symptoms and impairment in functioning. The objective of the study was to explore the interplay between positive symptoms, negative symptoms, neurocognition, social cognition and functional outcome in patients with schizophrenia using network analysis. Methods: Participants were 64 clinically stable patients with schizophrenia. Psychopathologic, neurocognition, social cognition, and functional outcome were measured using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Addenbrooke’s Cognitive Examination III, Faces test, Reading the Mind in the Eyes test, and Personal Social Performance scale. Results: The network analysis suggested that functional outcome was the most central in the network followed by avolition and asociality. Functioning was directly connected to avolition, asociality, blunted affect, neurocognition and emotion recognition. The positive symptoms were the most remote and therefore the least important node. Conclusion: The high centrality of functioning suggests the need for improving of everyday life skills for patients with schizophrenia. Moreover, treatment of specific negative symptoms, neurocognition and emotion recognition could also enhance functional outcome.

Repeating, counting, and touching to prevent harm

Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning. Obsessions are recurrent and persistent intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress. Examples of obsessions include worrying about germs, the feeling things need to be “just right,” worrying about bad things happening, and disturbing thoughts or images about hurting others. Compulsions are repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. Examples of compulsions include washing, checking, tapping, ordering, and repeating. Young children may not be able to articulate the aims of these repetitive behaviors or mental acts. Selective serotonin reuptake inhibitors (SSRIs) are the first-line class of medications used to treat OCD in children and adolescents. Exposure and response prevention (ERP) therapy is the gold standard psychotherapy treatment for OCD.

A fear of dogs

Specific phobia is a marked fear or anxiety about a specific object or situation. The fear or anxiety is out of proportion to the actual danger posed by the situation and the symptoms cause clinically significant distress or impairment in functioning. Often patients have more than one specific phobia. Children may be less able to spontaneously articulate their fears and the presenting symptoms may include nonspecific behaviors such as crying, tantrums, freezing, or clinging. A specific phobia can be distinguished from a developmentally appropriate fear by the persistence, severity, and degree of associated functional impairment. The treatment of choice for specific phobia is cognitive behavioral therapy (CBT) including exposure therapy and systematic desensitization.

Exploring the Interplay Between Adversity, Neurocognition, Social Cognition, and Functional Outcome in People With Psychosis: A Narrative Review

History of adversity is associated with subsequent psychosis, and with a spectrum of cognitive alterations in individuals with psychosis. These cognitive features go from neurocognitive aspects as working memory and attention, to complex social cognitive processes as theory of mind and emotional perception. Difficulties in these domains impact patients' social and occupational functioning, which has been shown to be more impaired in those previously exposed to childhood trauma. However, the interplay between adversity, neurocognition, and functioning is yet poorly understood. This narrative review aims to explore the evidence on whether deficits in neurocognitive and social cognitive domains may act as possible putative mechanism linking adversity with functioning in people with psychosis. We show available evidence supporting the link between adversity and poorer functioning in psychosis, especially in chronic stages; and replicated evidence suggesting associations of social cognition and, to a lesser extent, neurocognition with impairment in functioning in patients; although there is still an important gap in the literature testing particularly deficits in social cognition as mediator of the link between adversity and functional decline in psychosis. Targeting interventions focusing on neurocognition and social cognition in individuals with adversity and psychosis seems important, given the severe deterioration of these patients in these domains, although more research is needed to test whether such treatments can specifically improve functioning in individuals with psychosis and adversity. Literature aiming to understand the determinants of functional outcome should consider the pervasive impact of childhood adversity, and its related effects on cognition.

Comparison of The Effects of Methylphenidate Plus Betahistine and Methylphenidate Plus Placebo on Attention Deficit Hyperactivity Disorder in Children

Background: Attention deficit hyperactivity disorder (ADHD) is a common disorder during childhood that leads to impairment in functioning in academic and career domains and social responsibility. Methylphenidate is a common treatment for ADHD that may not be taken by patients due to its complications. The goal of the present study is to examine and compare the effects of Methylphenidate plus Betahistine and Methylphenidate plus placebo on ADHD in Children.Methods: This was a randomized double-blind clinical trial with control group conducted with 76 children with ADHD referred to Be’sat Hospital in Sanandaj, Iran in 2019. The data was collected using the demographic form, a researcher-made form for assessing the reported complications of Methylphenidate and Betahistine, ADHD Rating Scale and the Clinical Global Impression – Severity scale (CGI-S).Results: There was no age difference between the two experimental groups. Both groups experienced a reduction in intensity of ADHD symptoms according to mean scores, but there was more reduction in the Methylphenidate plus Betahistine than the other group. The most common complications in the two groups were lack of appetite (weeks 2 and 4) and agitation and vertigo (week 2).Conclusion: Betahistine plus Methylphenidate may be more effective in treating ADHD symptoms compared to Methylphenidate alone.

Bipolar and Related Disorders

Bipolar disorder is a debilitating mental health condition marked by episodes of mania or hypomania and depression. A person with bipolar disorder cycles between these mood episodes throughout his or her lifetime, leading to significant impairment in functioning and overall quality of life. Sleep disturbances pervade the course of bipolar disorder, occurring before, during, and after mood episodes. Sleep disturbances also negatively impact the treatment outcome for individuals with bipolar disorder. Thus, interventions aimed at improving sleep in this clinical population are needed. This chapter discusses sleep disturbances in the context of bipolar disorder as well as empirically validated strategies to improve sleep specifically for bipolar disorder.

Sexual deviances

Mental disorder is a significant behavioural or psychological syndrome or pattern that occurs in an individual and is associated with distress, impairment in functioning, or increased risk of suffering, death, pain, disability, or an important loss of freedom. It is a manifestation of a behavioural, psychological, or biological dysfunction in the individual. Socio-environmental factors can lead to an intellectually deficient individual to a deviant sexuality. Individuals with intellectual disabilities have problematic behaviour including, aggressive behaviour towards others and destructive acts. Some problematic behaviour includes a sexual component. Keywords: sexual deviances, mental disorder.

Sleep Disturbance in Adjustment Disorder and Depressive Episode

Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants’ sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms—Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p < 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in adjustment disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE.

Outpatient Settings: The Collaborative Role of Psychiatry and Psychology

Best practices in child and adolescent mental health often point to multimodal treatments for moderate-to-severe distress and impairment in functioning. Mental health professionals, however, are not often experienced in recognizing and addressing various factors that promote or impede effective collaboration by clinicians of diverse training or orientation. This chapter presents the role of child psychiatrists in working within a collaborative care model with clinical child and adolescent psychologists. Discussed are the benefits and barriers to collaborative clinical care, strategies for addressing sometimes complex administrative issues, and models for promoting professional development and supervision within a collaborative care team. Optimizing patient benefits and reducing risk are key positive outcomes in productive collaboration between medical and psychosocial treatment providers.