December 2017 - Volume 205 - Issue 12

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • 1.860


Bipolar Disorder and Cognitive Dysfunction: A Complex Link
Gabriele Cipriani, MD, Sabrina Danti, PhD, Cecilia Carlesi, MD, Davide Maria Cammisuli, PhD, Mario Di Fiorino, MD

The aim of this article was to describe the current evidence regarding phenomenon of cognitive functioning and dementia in bipolar disorder (BD). Search terms used included "bipolar disorder," "cognitive dysfunction," and "dementia." 159 studies were included in our qualitative synthesis. Nowadays, there is evidence of stable and lasting cognitive dysfunctions in all phases of BD, including remission phase, particularly in: attention, memory, and executive functions. The cause of cognitive impairment in BD raises the question if it subtends a neurodevelopmental or a neurodegenerative process. Impaired cognitive functioning associated with BD may contribute significantly to functional disability, in addition to the distorted affective component usually emphasized.


Disclosure of Diagnosis in Early Recognition of Psychosis
Andreas Blessing, PhD,  Anna Studer, MSc, Amelie Gross, PhD,  L. Forest Gruss, PhD, Roland Schneider, Gerhard Dammann, PD, PhD

We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health.

What Predicts Ongoing Nonsuicidal Self-Injury? A Comparison Between Persistent and Ceased Self-Injury in Emerging Adults
Glenn Kiekens, MSc, Penelope Hasking, PhD, Ronny Bruffaerts, PhD, Laurence Claes, PhD, Imke Baetens, PhD, Mark Boyes, PhD, Philippe Mortier, MD, Koen Demyttenaere, PhD, MD, Janis Whitlock, PhD

Although nonsuicidal self-injury (NSSI) peaks in adolescence, a significant proportion of young people continue to self-injure into emerging adulthood. Using data from a 3-year longitudinal study (n = 1466), we compared 51 emerging adults (67.3% female; average age, 20.0 years) who continued to self-injure from adolescence and 50 emerging adults (83.7% female; average age, 20.3 years) who had ceased NSSI, on a broad range of psychosocial factors. More frequent NSSI, use of a greater number of methods, specific NSSI functions, academic and emotional distress, and lack of perceived emotion regulatory capability differentiated emerging adults who continued with NSSI and those who had ceased the behavior. Further, the relationships between social support, life satisfaction, and NSSI were mediated by perceived ability to regulate emotion.

In Their Own Words: Perspectives on Nonsuicidal Self-Injury Disorder Among Those With Lived Experience
Stephen P. Lewis, PhD, Lindsay A. Bryant, BAH, Brittany M. Schaefer, BAH, Paul H. Grunberg, BAH

Seventy-six participants with a nonsuicidal self-injury (NSSI) history completed quantitative and qualitative measures assessing perspectives about NSSI being included as a DSM disorder. Findings revealed mixed views overall. Thematic analysis of open-ended responses highlighted several unique advantages (i.e., enhanced understanding of NSSI, validation of the NSSI experience, facilitation of NSSI treatment, encouragement of NSSI help-seeking, reduction of NSSI stigma) and disadvantages (i.e., exacerbation of NSSI stigma, diminishment of underlying concerns).

Risk Factors of Delayed Onset Posttraumatic Stress Disorder in Chronically Critically Ill Patients
Gloria-Beatrice Wintermann, PhD, Jenny Rosendahl, PhD, Kerstin Weidner, MD, Bernhard Strauß, PhD, Katja Petrowski, PhD

The main aim of this study was to investigate factors associated with a delayed-onset posttraumatic stress disorder (PTSD) after the intensive care unit (ICU) treatment of patients with a chronic critical illness (CCI). Patients (n = 97) with critical illness polyneuropathy or critical illness myopathy were interviewed. The diagnosis of the acute stress disorder was assessed within 1 month (t1), the diagnosis of PTSD at 3 (t2) and 6 (t3) months after transfer from the acute care ICU to the post-acute ICU. Patients showing a delayed-onset or persistent course of PTSD were subsumed in one group; 24.7% (n = 24) showed a delayed-onset PTSD. Significant risk factors were as follows: the severity of the medical illness, the perceived fear of dying at the ICU, the number of traumatic memories from the ICU, and the presence of a coronary heart disease. Every fourth patient with CCI showed a delayed-onset PTSD up to 6 months after the ICU treatment.

Depression in Kidney Transplant Recipients: Prevalence, Risk Factors, and Association With Functional Disabilities
Maytinee Srifuengfung, MD, Kajohnsak Noppakun, MD, Manit Srisurapanont, MD

We conducted a cross-sectional, observational study in 217 consecutive kidney transplant (KT) recipients. Twenty-eight (12.9%) patients had depression (PHQ-9 score, ≥10). A binary logistic regression analysis found that the CCI score was significantly higher in KT recipients with depression (β = 0.54, p < 0.01). After the adjustment of education and glomerular filter rates, an ordinal logistic regression analysis revealed that the PHQ-9 scores were positively correlated with the WHODAS scores (β = 0.39, p < 0.01). In KT recipients, physical comorbidity is associated with depression, and depression is correlated with functional disability.

Alcohol Use Disorder Moderates the Effect of Age on Heart Rate Variability in Veterans With Posttraumatic Stress Disorder
John M. Ray, PhD, Jeffrey M. Pyne, MD, Richard N. Gevirtz, PhD

Research on heart rate variability (HRV) in posttraumatic stress disorder (PTSD) and comorbid alcohol use disorder (AUD) is limited despite its use as a biomarker of both disorders. This study examined whether AUD comorbidity contributes an additive effect on HRV for veterans with PTSD. HRV was assessed in 70 male Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD, including 32 with co-occurring AUD. Mean HRV values for both groups were below the mean for healthy adults, but additive effects of PTSD and AUD on HRV were not observed. Consistent with prior studies, hierarchical regressions showed that HRV decreased with age in the PTSD-only group. However, HRV increased slightly with age among veterans with both PTSD and AUD. This interaction remained significant after controlling for common HRV covariates. These findings support HRV as a biomarker of PTSD and extend research by demonstrating the complex relationship between PTSD and HRV in the context of co-occurring AUD.


The Relation Between Mastery, Anticipated Stigma and Depression Among Older Adults in a Primary Care Setting
Elmira Raeifar, MSc, MA, Ashley Halkett, Mphil, Matthew C. Lohman, PhD, Jo Anne Sirey, PhD

The current study evaluates the interaction between mastery, depression, and psychological barriers to care among older adults in a primary care setting, including the longitudinal effects of anticipated stigma and mastery on depressive symptoms. The sample was composed of 70 depressed older adults (age ≥ 60) who were newly recommended antidepressant treatment by their physicians. This cohort is part of a larger study examining the usefulness of the Treatment Initiation and Participation program to improve medication adherence. Anticipated stigma significantly predicted greater depression among older adults with low mastery, but not among those with high mastery. Mastery was found to moderate the relationship between anticipated stigma and depressive symptoms among older adults. Increased mastery over 28 weeks was also associated with greater reductions in depressive symptoms at follow-up, controlling for antidepressant strength and adherence. Bolstering older adults' sense of mastery in treatment could provide a source of resilience for older adults facing depression.

Longitudinal Changes in Combat-Related Posttraumatic Stress Disorder Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Hazardous Alcohol Use: The Role of Avoidance Coping
Joohyun Lee, MS, Kyle Possemato, PhD, Paige C. Ouimette, PhD

This longitudinal study examined a number of pre-, peri-, and postdeployment factors hypothesized to contribute to PTSD symptomatology among returning Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans, who were presenting with at least subthreshold PTSD symptoms and hazardous alcohol use in a primary care setting. Purported risk factors included childhood family environment, severity of combat exposure, postdeployment social support, alcohol dependence severity, and an avoidant coping style. At baseline, postdeployment social support and avoidant coping contributed to PTSD severity. Only avoidant coping was associated with changes in PTSD symptom at 1-year follow-up. Reducing avoidant coping may deter the maintenance of PTSD among veterans with PTSD symptoms and hazardous alcohol use.

Political Affiliation, Probable PTSD, and Symptoms of Depression in Iraq and Afghanistan Combat Veterans: A Pilot Study
Jeffrey M. Lating, PhD, Rich A. Moore, PsyD, Martin F. Sherman, PhD, Matthew W. Kirkhart, PhD, George S. Everly, Jr, PhD,† Justin K. Chen, PsyD*

This pilot study assessed whether Democratic and Republican political affiliation differentially predicted probable posttraumatic stress disorder (PTSD) and symptoms of depression in 62 male Iraq and Afghanistan combat veterans. The Liberalism-Conservatism Scale, the PTSD Checklist-Military Version (PCL-M), and the Patient Health Questionnaire–9 (PHQ-9) were assessment measures. Results revealed that Democratic combat veterans had stronger liberal attitudes than Republican combat veterans (r = 0.95). Moreover, of the 50% of the entire sample higher than the cutoff score of 50 on the PCL-M, 84.8% were Democrats compared with 10.3% of Republicans. On the PHQ-9, 46.9% of Democrats compared with 3.7% of Republicans were higher than the cutoff score of 20. These initial results suggest possible mechanisms of action, including differences in shattered world view assumptions, willingness to disclose emotional concerns, and physiological reactions between Democratic and Republican combat veterans.

Thinking About One's Feelings: Association Between Alexithymia and Cognitive Styles in a Nonclinical Population​
Romina Rinaldi, PhD, Viorica Radian, Mandy Rossignol, PhD, Kendra G. Kandana Arachchige, Laurent Lefebvre

A total of 685 participants from a nonclinical sample completed the Toronto Alexithymia Scale–20 along with self-reported and behavioral measures of cognitive styles. Results suggest that people with a high level of self-reported alexithymia show lower rational abilities. The findings of this study extend previous work on cognitive processes underlying emotional self-regulation impairments in alexithymia, suggesting that these difficulties may be linked to a poorer use of rational process.


Future Directions in Vitamin D Research in Psychiatry
Colin A. Ross, MD

INVITED COMMENTARY                                                                                                             

Commentary on "Future Directions in Vitamin D Research in Psychiatry"​​​
José Salavert, MD, PhD


Posttraumatic Stress Disorder and its Predictors in Adolescents After Earthquake in China
Tomoyuki Kawada, MD, PhD


Integrating Behavioral Health and Primary Care. Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein (2017) Oxford: Oxford University Press. 592 pp., Pedro Ruiz, MD.













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