Insomnia in depression is common and difficult to resolve. Music is commonly used as a sleep aid, and clinical trials pointing to positive effects of music as a sleep aid are increasing adding to the evidence base. There is little knowledge on the effectiveness of music for depression related insomnia.

A recent RCT study conducted in psychiatry at Aalborg University Hospital examined effects of a music intervention for insomnia in depression. The intervention group listened to music at bedtime for four weeks, controls were offered music intervention post-test. Primary outcome measure was Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included Actigraphy, The Hamilton depression Rating Scale (HAMD-17) and World Health Organisation well-being questionnaires (WHO-5, WHOQOL-BREF).

A two-armed randomized controlled trial (n=112) and a qualitative interview study (n=4)

The RCT study showed signficant improvements for the music intervention group in sleep quality and quality of life at four weeks according to global PSQI scores (effect size= -2.1, 95%CI -3.3; -0.9) and WHO-5 scores (effect size 8.4, 95%CI 2.7; 14.0). Actigraphy measures showed no changes and changes in depression symptoms (HAMD-17) were not detected.

The interview study unfolded examples of the influences of music on sleep and relaxation. Music distracted, affected mood and arousal positively and supported formation of sleep habits.

Results from the trial are discussed and merged with findings from the interview study. The results from the trial suggested moderate effects of music listening for the population while findings from the interview study showed examples of individual and highly varying outcomes.

Music is suggested as a low-cost, side-effect free and safe intervention in supplement to existing treatments improving sleep in depression.

None Declared

To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics.

FEP (N = 191) were recruited from in- and outpatient services 1997–2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15–65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale.

CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms.

Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.

A subgroup of patients with anorexia nervosa (AN) undergoing involuntary treatment (IT) seems to account for most of the IT events. Little is known about these patients and their treatment including the temporal distribution of IT events and factors associated with subsequent utilization of IT. Hence, this study explores (1) utilization patterns of IT events, and (2) factors associated with subsequent utilization of IT in patients with AN.

In this nationwide Danish register-based retrospective exploratory cohort study patients were identified from their first (index) hospital admission with an AN diagnosis and followed up for 5 years. We explored data on IT events including estimated yearly and total 5-year rates, and factors associated with subsequent increased IT rates and restraint, using regression analyses and descriptive statistics.

IT utilization peaked in the initial few years starting at or following the index admission. A small percentage (1.0%) of patients accounted for 67% of all IT events. The most frequent measures reported were mechanical and physical restraint. Factors associated with subsequent increased IT utilization were female sex, lower age, previous admissions with psychiatric disorders before index admission, and IT related to those admissions. Factors associated with subsequent restraint were lower age, previous admissions with psychiatric disorders, and IT related to these.

High IT utilization in a small percentage of individuals with AN is concerning and can lead to adverse treatment experiences. Exploring alternative approaches to treatment that reduce the need for IT is an important focus for future research.

1. (1) Self-tracking with the One Button Tracker is a novel symptom registration method, particularly suited for use in psychotherapeutic treatment and research.

2. (2) Rumination and intrusions appear to the participants as distinct cognitive phenomena and treatment targets in PTSD.

3. (3) Registering rumination and intrusions in real-time could reveal important temporal relations between them and the contexts in which they occur.

4. (4) The data obtained with this self-tracking method can potentially be used as a tool in, and for the further development of psychotherapy for PTSD.

The INSYTE study provides an understanding of the management of Parkinson disease psychosis (PDP) in actual practice settings, including use of antipsychotic (APs) and their impact on clinical, economic, and humanistic outcomes. Treatment paradigms or the benefits/consequences of various “real world” PDP treatment strategies have not been evaluated. Thus, providers may be using a wide range of AP treatment strategies that contrast with consensus recommendations.

The INSYTE study is enrolling up to 750 patients from up to 100 sites in the US. Data are compiled at the baseline (BL) visit and from standard-of-care follow up visits over 3 years. PDP treatment pathways are defined from 3 BL cohorts reflecting (1) no AP medication, (2) use of pimavanserin (PIM), or (3) other AP treatment. Information about APs used is collected at each follow-up visit: history, duration, dose, adjustment, and rationale for adjustment of treatment. Outcomes assessments (clinical, quality of life, disease burden) by the physician, patient, and caregiver are also collected. AP medication and outcomes data are analyzed for patients completing a BL and 1 follow up visit (FU1).

For 404 patients with BL and FU1 visits (mean 120.7 days from BL), 56.8% used no AP medications, 26.0% used PIM, and 13.6% used other APs at BL. The No Medication group was noted to be less severe in key BL disease parameters. Considering primary PDP treatments at BL and FU1 (including no treatment), 26 distinct pathways were being employed. 12.6% of patients had AP medication adjustments between BL and FU1 visits, most frequently from the non-PIM group. Adjustments of APs occurred in many forms: introduction of a single AP (64.7%%), introduction of multiple APs (5.9%), switching to another AP (3.9%), decreasing the number of APs (5.9%), and discontinuation (19.6%).

Multiple, divergent AP treatment strategies for PDP exist in actual practice. No identifiable BL characteristics correlated with the broad range of AP treatment pathways. The numerous distinct AP treatment pathways utilized (n=26) reflect discordance with the updated 2019 MDS evidence-based recommendations, which recognize only 2 APs as “efficacious” and “clinically useful”: pimavanserin and clozapine. Education of healthcare professionals remains a priority for PDP management.

ACADIA Pharmaceuticals Inc.

Atopic disorders, including asthma, dermatitis and rhinoconjunctivitis are the most common chronic diseases of childhood. Numerous studies have investigated the relationship between immune dysregulation and prenatal factors, including psychological stress. The association between prenatal maternal stress and atopy, however, has never been systematically reviewed.

To systematically review all observational studies on the association between prenatal maternal stress and atopic disorders or predisposition in childhood.

To identify all observational studies in humans that compared the prevalence of one or more atopic disorders or predispositions in children of exposed and unexposed mothers. To critically evaluate the quality and validity of the published literature.

PubMed, EMBASE, PSYCInfo and Scopus databases were searched and relevant studies were identified and assessed accordingly to the PRISMA-criteria.

Fifteen studies met the inclusion criteria, many of which examined the association between prenatal stress and multiple disorders. Preliminary results suggest that children of mothers who experienced stress during pregnancy have a higher risk of developing asthma, dermatitis and rhinoconjunctivitis than children of unexposed mothers.

The impact of psychological stress on immune function appears consistent regardless of stress-definition. The varying stress- and outcomes measures make it difficult to compare results from the studies. Future research should focus on whether certain disorders are more susceptible than others, as well as if certain stressor-types or times during pregnancy are more critical.

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Conditions of depression and anxiety among employees’ leads to increased absenteeism and decreased social and professional function.

To test a collaborative model for contributing to mental health at work at the lowest interference and highest possible availability among Danish workers.

To investigate the effect of early detection and treatment in order to interrupt and improve conditions of clinical and sub-clinical levels of mental illness.

Self-reporting questionnaires were used for identification of clinical and sub-clinical cases of mental illness and for follow-up. Four questionnaires were distributed to all employees in six medium-large companies in Denmark (n = 1292) during a period of 16 months. Employees meeting the screening criteria were assessed diagnostically. Outpatient psychiatric treatment was offered to employees diagnosed with mental illness and preventive CBT-session to those assessed with sub-clinical conditions. Follow-up questionnaires were filled out after 6 and 12 months. Data were analysed using repeated measure mixed effects linear regression.

Of the 587 (55%) employees that returned the questionnaires, 58 were referred to either outpatient psychiatric treatment (n = 38) or preventive treatment (n = 20). Levels of psychopathology decreased significantly in both treated groups. Comparing with the pre-treatment period, a significant positive difference in change in psychopathology was detected for employees in psychiatric treatment. Measured up to healthy controls, the self-perceived level of stress also decreased significantly among employees in psychiatric treatment.

An integrated collaborative model for early detection and treatment was beneficial in order to interrupt and improve the course of mental health problems among Danish employees.

The authors have not supplied their declaration of competing interest.

Suicide is a leading cause of death worldwide and is largely preventable. The social media site Twitter is used by individuals to express suicidal intentions. It is not yet feasible to contact each Twitter user to confirm risk. Instead, it may be possible to validate risk by linguistic analysis. Psychological linguistic theory suggests that language is a reliable way of measuring people's internal thoughts and emotions; however, the linguistics of suicidality on Twitter is yet to be fully explored.

The aim of this study is to characterise the linguistic styles of suicide-related posts on Twitter for the purposes of predicting suicide risk.

The Linguistic Inquiry and Word Count (LIWC) program was used to compare the linguistic features of suicide-related tweets previously coded for suicide risk by humans with a set of matched controls. Logistic regression was then used for predictive modelling.

The suicide-related tweets had significantly different linguistic profiles to the control tweets. The “strongly concerning” suicide tweets were found to have fewer words than all other tweets and not surprisingly, references to ‘death’ were significantly higher in this group. A number of other results were found. The final model which distinguished “strongly concerning” suicide risk from the controls was found to have 97.7% sensitivity and 99.8% specificity.

This study confirms that the linguistic features of suicide-related Twitter posts are different from general Twitter posts and that these linguistic profiles may be used to predict suicide risk in Twitter users.

The authors have not supplied their declaration of competing interest.