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Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
Cystoisospora belli is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.
Traumatic brain injury (TBI) is common among children. However, their caregivers’ knowledge and understanding of symptoms may influence how the injury is managed.
To investigate the knowledge of New Zealand (NZ) parents about TBI and concussion.
Method and procedures:
Parents (n = 205) of children aged 5–13 years completed a pen-and-paper or online survey containing questions examining their knowledge of TBI terminology, TBI symptoms and knowledge about concussion management.
Main outcomes and results:
A high proportion (61%) of parents did not think that a concussion was the same as a brain injury. Loss of consciousness (LOC) was the most endorsed symptom of TBI. However, 69% of participants were aware that TBI could occur without LOC. On average, parents correctly identified 19.5 (67.3%) of the 29 symptoms of TBI, but also identified 2.0 (11.9%) of the 17 distractor symptoms as being TBI related. Demographic factors and experience of TBI/concussion were associated with TBI symptom identification accuracy and concussion knowledge.
Further education of parents is needed to ensure they recognise the signs and symptoms of concussion/mild TBI so that they can make informed decisions on how best to manage their child’s injury.
Exercise has potential to mitigate morbidity in knee osteoarthritis (OA). Participants with knee OA were randomized to a Square-stepping Exercise (SSE) group (2x/week for 24 weeks) or a control group. We assessed the feasibility of SSE and its effectiveness on symptoms (WOMAC), balance (Fullerton), mobility, and walking speed at 12 and 24 weeks. The SSE group had a 49.3% attendance rate and trended toward improvement in the 30-second chair stand at 12 (F = 1.8, p = .12, ηp2 = 0.16), and 24 weeks, (F = 3.4, p = .09, ηp2 = 0.18), and walking speed at 24 weeks, compared to controls. There were no differences in symptoms or balance. The low attendance and recruitment demonstrated limited feasibility of SSE in adults with knee OA. Trends suggest the potential for SSE to improve lower extremity functional fitness and walking speed. SSE should be further studied for effectiveness on symptoms and balance, in addition to improving feasibility.
Clinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.
The sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.
Patients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.
Significance of results
Depression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.
Objectives: This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. Methods: A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. Results: Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ2=37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ2=10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ2=12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). Conclusions: Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete’s sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476–485)
Current psychiatric diagnostic practice is usually based on groups of symptoms reported by patients which are compared with symptom clusters in recognized diagnostic classifications, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The number of psychiatric diagnoses has increased in each edition of DSM, which may not be in the best interest of those we treat. Some of the issues with increasing diagnostic categories include potential for overmedicalization, lack of scientific evidence relating to each diagnostic category, and clinician efforts to make a precise diagnosis too early when a more longitudinal assessment is necessary. Clinicians should be mindful of this in their practice and ensure that the unique life experience of each individual is considered in clinical encounters.
Exposure to traumatic experiences in childhood is a risk (and potentially causal) factor for the development of a range of adverse physical and mental health conditions. In addition to the onset of clinical disorders, there is emerging evidence that childhood trauma may also be associated with other long-term outcomes, such as the persistence and severity of an individual’s symptoms, as well as their long-term social and occupational functioning. However, the reasons for this remain poorly understood. A greater understanding both of the mediators that drive these associations, and those variables that enhance resilience against such damaging experiences may help to inform effective therapeutic interventions. In addition to biological and cognitive measures, there is a need to consider social and environmental factors, such as parental bonding and attachment, when investigating these complex relationships.
Insight into symptoms as predictors for anxiety may help to foster early identification of anxiety and to ameliorate anxiety management. The aim of this study was to determine which frequently occurring symptoms are predictors for anxiety in advanced cancer patients recently admitted to a hospice.
Symptom burden was measured in patients admitted to a hospice who died ≤3 month after admission using the Utrecht Symptom Diary. This is a Dutch-translated and adapted version of the Edmonton Symptom Assessment System to self-assess the 11 most prevalent symptoms and overall well-being on a 0–10 numerical rating scale. Multiple linear regression analysis was employed to analyze the predictive value of fatigue, nausea, pain, dyspnea, depressed mood, insomnia, and well-being on anxiety.
A total of 211 patients were included, 42% of whom were men, and the median age was 71 years (range = 31–95). Anxiety was uncommon and rarely severe: 25% had a score ≥1, and 14% had a score >3. After correction for age, gender, and marital status, depressed mood (p = 0.00) and dyspnea (p = 0.01) were independent predictors for anxiety and explained 23% of the variance in anxiety.
Significance of results:
Hospice inpatients with advanced cancer who suffer from dyspnea and/or depressed mood are at increased risk for anxiety. Treatment of dyspnea and depressed mood may contribute to adequate anxiety management. Further research should explore other factors associated with anxiety, especially in the psychological, social, and spiritual domains.
Literature has shown that obesity, metabolic syndrome and inflammation are associated with depression, however, evidence suggests that these associations are specific to atypical depression. Which of the atypical symptoms are driving associations with obesity-related outcomes and inflammation is unknown. We evaluated associations between individual symptoms of depression (both atypical and non-atypical) and body mass index (BMI), metabolic syndrome components and inflammatory markers.
We included 808 persons with a current diagnosis of depression participating in the Netherlands Study of Depression and Anxiety (67% female, mean age 41.6 years). Depressive symptoms were derived from the Composite International Diagnostic Interview and the Inventory of Depressive Symptomatology. Univariable and multivariable regression analyses adjusting for sex, age, educational level, depression severity, current smoking, physical activity, anti-inflammatory medication use, and statin use were performed.
Increased appetite was positively associated with BMI, number of metabolic syndrome components, waist circumference, C-reactive protein and tumor necrosis factor-α. Decreased appetite was negatively associated with BMI and waist circumference. Psychomotor retardation was positively associated with BMI, high-density lipoprotein cholesterol and triglycerides, and insomnia with number of metabolic syndrome components.
Increased appetite – in the context of a depressive episode – was the only symptom that was associated with both metabolic as well as inflammatory markers, and could be a key feature of an immuno-metabolic form of depression. This immuno-metabolic depression should be considered in clinical trials evaluating effectiveness of compounds targeting metabolic and inflammatory pathways or lifestyle interventions.
Due to the multiple physical, psychological, existential, and social symptoms involved, patients with advanced cancer often have a reduced quality of life (QoL), which requires specialized palliative care (SPC) interventions. The primary objective of the present systematic review was to review the existing literature about SPC and its effect on QoL, on physical and psychological symptoms, and on survival in adult patients with advanced cancer.
We utilized a search strategy based on the PICO (problem/population, intervention, comparison, and outcome) framework and employed terminology related to cancer, QoL, symptoms, mood, and palliative care. The search was performed in Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Selected studies were analyzed and categorized according to methods, results, quality of evidence, and strength of recommendation.
Six randomized controlled trials (RCTs) were selected for analysis (out of a total of 1,115 studies). Two other studies were found by hand search, one of which was only published in conference abstract form. The RCTs differed in terms of aims, interventions, control groups, and outcomes; however, the primary aim of all of them was to investigate the effect of SPC on patient QoL. Five studies found improved QoL in the intervention group. Physical symptom intensity decreased in two studies, and three studies found improved mood in the intervention group. However, physical and psychological symptoms were secondary outcomes in these studies. Survival was improved in two studies. All the studies offered generalizability, but the level of evidence validity varied among them.
Significance of results:
Due to several methodological limitations, the evidence offered in these studies ranged from low to high. The evidence in this field of study in general is still nascent, but there is growing support for the utilization of SPC to improve the quality of life of adult patients with advanced cancer. The evidence that SPC reduces physical and psychological symptoms is moderate, while the evidence that it prolongs survival is low.
Computer models can be useful in planning interventions against novel strains of influenza. However such models sometimes make unsubstantiated assumptions about the relative infectivity of asymptomatic and symptomatic cases, or conversely assume there is no impact at all. Using household-level data from known-index studies of virologically confirmed influenza A infection, the relationship between an individual's infectiousness and their symptoms was quantified using a discrete-generation transmission model and Bayesian Markov chain Monte Carlo methods. It was found that the presence of particular respiratory symptoms in an index case does not influence transmission probabilities, with the exception of child-to-child transmission where the donor has phlegm or a phlegmy cough.
This study examined insomnia in the context of breast cancer, both as an independent symptom and as a component of a symptom cluster that includes depression, anxiety, fatigue, and pain.
Women with a history of breast cancer currently taking an aromatase inhibitor and who had completed cancer treatment at least one month prior to enrollment were included (n = 413). Participants completed validated measures of insomnia, fatigue, pain, depression, and anxiety. Factor analysis was utilized to examine the extent to which these symptoms could be represented by common latent factors. Insomnia severity was then separated into a symptom cluster component (I–SC) and an insomnia-unique (I–U) component. The associations between each insomnia component and demographic and clinical factors were examined in multivariate models.
A single-factor solution provided the best fit to the symptom measures. Some 53.3% of the variance in insomnia severity was captured by this symptom cluster (I–SC), with the remaining 43.7% being unique to insomnia (I–U). Unique patterns of demographic factors (e.g., age and body–mass index), but not clinical factors, were associated with each insomnia measure.
Significance of results:
Approximately 50% of insomnia severity was related to the symptom cluster, with the rest being unique to insomnia. Different sociodemographic risk factors were related to the different insomnia measures. Stronger underlying foundations for the mechanisms of each component could lead to refined diagnoses and targeted interventions for addressing the overall insomnia burden in cancer patients.
Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included.
A PICO process search strategy consisting of terms related to cancer, palliation, and home care was employed. The search was conducted in PubMed, EMBASE, and Cochrane from January 1, 2000, to January 27, 2015. A hand search of the reference lists of the included studies was also performed.
A total of 5 articles (out of 2080 abstracts) were selected for analysis. Three additional studies were added by the hand search. Six observational and two interventional studies were evaluated. In all of these studies, the description of the SPC service was limited to the composition of the staff—no other organizational aspects were detailed. From 44 to 90% of the patients receiving home-based SPC died at home. Studies including survival and quality of life had divergent outcomes, and overall performance status did not improve. However, symptom control did improve over time.
Significance of results:
There is a lack of controlled clinical trials and organizational descriptions regarding home-based SPC for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required.
This study aimed to explore whether aesthetic beauty and the pleasure that results from artistic activity can contribute to a reduction in the symptoms experienced by palliative care patients, and to improve the effectiveness of art therapy sessions.
A self-assessment of six symptoms (pain, anxiety, ill-being, tiredness, sadness, and depression) adapted from the Edmonton Symptom Assessment System (ESAS) was completed by patients before and after a one-hour art therapy session. This assessment was completed after the session with a self-assessment of aesthetic feeling. A correlation analysis was then performed.
From July of 2012 to December of 2013, 28 patients took part in 63 art therapy sessions. On the whole, these sessions reduced the global distress of patients by 47% (p < 0.0001). There was a significant reduction in all the symptoms studied; pain (p = 0.003), anxiety (p < 0.0001), ill-being (p < 0.0001), tiredness (p < 0.0001), sadness (p < 0.0001), and depression (p < 0.0001). A study of the significant correlations (0.35 < rs < 0.52, p < 0.05) indicated that technical satisfaction, aesthetic beauty, and pleasure are all involved to varying degrees in reduction of symptoms.
Significance of results:
Our findings confirm the benefits of art therapy in reducing distress within the palliative context. We also make suggestions for the future direction and improvement of these sessions.
Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression.
One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood.
The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous.
Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.
Prospective studies on the relationship between course of cannabis use and clinical outcome in patients with non-affective psychotic disorders are inconclusive. The current study examined whether (1) persistent, recently started, discontinued and non-cannabis-using patients with a psychotic disorder differed with regard to illness outcome at 3-year follow-up, and (2) whether timing of cannabis discontinuation was associated with course of clinical outcome.
This 3-year follow-up study was part of a multi-center study in the Netherlands and Belgium (Genetic Risk and Outcome of Psychosis; GROUP). We used mixed-model analyses to investigate the association between pattern of cannabis use and symptoms, global functioning and psychotic relapse.
In our sample of 678 patients, we found persistent users to have more positive and general symptoms, worse global functioning and more psychotic relapses compared with non-users and discontinued users [Positive and Negative Syndrome Scale (PANSS) positive, p < 0.001; PANSS general, p < 0.001; Global Assessment of Functioning (GAF) symptoms, p = 0.017; GAF disability, p < 0.001; relapses, p = 0.038]. Patients who started using cannabis after study onset were characterized by worse functioning at baseline and showed an increase in general symptoms (including depression and anxiety) at the 3-year follow-up (p = 0.005). Timing of cannabis discontinuation was not associated with clinical outcome.
These findings suggest that cannabis use in patients with a psychotic disorder has a long-lasting negative effect on illness outcome, particularly when persistent. Treatment should focus on discouraging cannabis use.
Haemorrhagic Nephritis Enteritis (HNEG) is caused by infection with haemorrhagic polyomavirus (GHPV) and is one of the major diseases of geese in Europe. Young geese (four to 10 weeks old) are susceptible to infection, and both horizontal and vertical transmission of GHPV has been confirmed. Infections result in significant gosling losses, with reports of up to 80% mortality. The most frequent pathological changes; haemorrhagic enteritis and inflammation of the kidneys give the disease its name. Additionally, oedema of subcutaneous tissues and visceral gout has been observed. Although it has been shown that GHPV infects Muscovy and mule ducks, these do not present with clinical symptoms, but can serve as reservoirs of infection for other species, including geese. There are no effective treatments for HNEG, however, data suggest that vaccination of breeders confers maternal immunity to goslings and that vaccination of day old goslings may prevent disease. In addition, reducing stress levels in these animals may prevent progression of HNEG.
Allergic rhinitis is inflammation of the nasal mucosa following exposure to allergens. A few studies have investigated how the Allergic Rhinitis and its Impact on Asthma classification correlates with symptom severity and skin prick test results in allergic rhinitis patients. Our objective was to evaluate such a correlation.
Materials and methods:
The study population consisted of 268 patients who had allergic symptoms and were diagnosed with allergic rhinitis.
Analysis of the Allergic Rhinitis and its Impact on Asthma classification with regard to symptom severity revealed that there were statistically significant differences between the groups for nasal symptoms, wheezing, eye itching/watering and eye redness. Symptom frequency and severity increased gradually towards the moderate to severe persistent allergic group. There was a statistically significant difference between the groups for grass pollen and house dust mite allergy.
The Allergic Rhinitis and its Impact on Asthma classification, which takes symptoms and quality of life into consideration in addition to allergen exposure, is a useful classification system for allergic rhinitis.
Accumulating evidence suggests that the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for cannabis abuse and dependence are best represented by a single underlying factor. However, it remains possible that models with additional factors, or latent class models or hybrid models, may better explain the data. Using structured interviews, 626 adult male and female twins provided complete data on symptoms of cannabis abuse and dependence, plus a craving criterion. We compared latent factor analysis, latent class analysis, and factor mixture modeling using normal theory marginal maximum likelihood for ordinal data. Our aim was to derive a parsimonious, best-fitting cannabis use disorder (CUD) phenotype based on DSM-IV criteria and determine whether DSM-5 craving loads onto a general factor. When compared with latent class and mixture models, factor models provided a better fit to the data. When conditioned on initiation and cannabis use, the association between criteria for abuse, dependence, withdrawal, and craving were best explained by two correlated latent factors for males and females: a general risk factor to CUD and a factor capturing the symptoms of social and occupational impairment as a consequence of frequent use. Secondary analyses revealed a modest increase in the prevalence of DSM-5 CUD compared with DSM-IV cannabis abuse or dependence. It is concluded that, in addition to a general factor with loadings on cannabis use and symptoms of abuse, dependence, withdrawal, and craving, a second clinically relevant factor defined by features of social and occupational impairment was also found for frequent cannabis use.