May 2018 - Volume 206 - Issue 5

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

REVIEW ARTICLE

Natural Medicines for Psychotic Disorders: A Systematic Review
Harm Jan Rogier Hoenders, MD, PhD, Agna A. Bartels-Velthuis, PhD, Nina K. Vollbehr, MSc, Richard Bruggeman, MD, PhD, Henderikus Knegtering, MD, PhD, and Joop T.V.M. de Jong, MD, PhD

A systematic literature search was performed through Medline, PsycINFO, CINAHL, and Cochrane until May 2015. In 110 randomized controlled trials, evidence was found for glycine, sarcosine, N-acetylcysteine, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol, and vitamin B6 to improve psychotic symptoms when added to antipsychotics. Ginkgo biloba and vitamin B6 seemed to reduce tardive dyskinesia and akathisia. Most study samples were small, study periods were generally short, and most results need replication. However, there is some evidence for beneficial effects of certain natural medicines.

ORIGINAL ARTICLES

Can We Predict and Prevent Subclinical Depression in Adolescents?
Lence Miloseva, PhD, Tatjana Vukosavljevic-Gvozden, PhD, Vladimir Milosev, MD, and Thompson Davis, PhD

The sample consisted of 412 adolescents (61.7% female, 38.3% male) aged 13 to 17 years. Cognitive vulnerability factors for depression and psychosocial risk factors were measured. Subsequent discriminant function analysis indicated that it was possible to distinguish groups on the basis of the mentioned predictors, and it allocated two discriminant functions (significant at p < 0.001). Unexpectedly, ruminative response style was the most powerful discriminative predictor possessing a positive and adaptive part and, at the same time, it maximally distinguished the subclinical group from the clinical and control groups.

Exploration of the Associations Between Responses to Affective States and Psychopathology in Two Samples of People Confronted With the Loss of a Loved One
Lonneke I.M. Lenferink, MSc, Ineke Wessel, PhD, and Paul A. Boelen

In two studies, using similar methods but different samples, we explored the association between positive (i.e., dampening and enhancing) and negative (i.e., rumination) affect regulation strategies and symptoms levels of post-loss psychopathology. Study 1 used data from 187 people confronted with the death of a loved one. In study 2, the sample consisted of 134 relatives of long-term missing persons. Participants completed self-reports, tapping prolonged grief, depression, posttraumatic stress symptoms, and affect regulation strategies. Hierarchical regression analyses showed that both negative and positive affect regulation strategies explained significant amounts of variance symptom levels in both samples.

Agreement Among Clinician, Patient, and Independent Interviewer Ratings of Adaptive Functioning
Ora Nakash, PhD, Maayan Nagar, PhD, and Drew Westen, PhD

A convenience sample of clinicians (N = 80) and patients (N = 170) from eight community mental health clinics in Israel participated in the study. Our findings suggest that clinicians overall reliably report on adaptive functioning of patients. Yet, in some areas, they may fail to collect necessary information such as self-mutilation history, loss of job in the past 5 years, and adult physical abuse. The patterns of higher versus lower diagnostic efficiency suggest that both treating clinicians and independent clinician interviewers tend to make judgments conservatively, essentially sacrificing sensitivity for specificity, not diagnosing events unless they were certain, thus maximizing false-negatives and minimizing false-positives.

Self-Reported Cognitive Biases Are Equally Present in Patients Diagnosed With Psychotic Versus Nonpsychotic Disorders
Tim Bastiaens, Msc, Laurence Claes, PhD, Dirk Smits, PhD, Dominique Vanwalleghem, MD, and Marc De Hert, PhD, MD

We investigated the relation between subjective cognitive biases measured with the Dutch Davos Assessment of Cognitive Biases (DACOBS-NL) and (1) the presence of a psychotic versus nonpsychotic psychiatric disorder, (2) the current dose of antipsychotic medication and current psychotic symptoms, and (3) the Personality Inventory for the DSM-5 (PID-5) Psychoticism personality trait. Results showed that DACOBS-NL subjective cognitive biases (1) were equally present in patients diagnosed with nonpsychotic disorders compared with patients with a psychotic disorder, (2) could not be explained by the current dose of antipsychotic medication, nor by current psychotic symptoms, and (3) significantly correlated with all PID-5 Personality domains. Further research is needed to clarify the interplay between cognitive biases and aberrant salience in the prediction of psychotic disorders.

Resilience, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Chinese Adolescents After a Tornado: The Role of Mediation Through Perceived Social Support
Guangzhe Yuan, MS, Wei Xu, PhD, Zhen Liu, MS, and Yuanyuan An, PhD

Previous studies have shown that resilience is associated with lower severity of posttraumatic stress disorder (PTSD) and more posttraumatic growth (PTG) in people who have experienced traumatic events. The present study investigated the ways in which resilience is related to PTSD symptoms and to PTG in Chinese traumatized adolescents by considering the role of perceived social support. A total of 247 Chinese adolescents who had experienced a severe tornado 3 months before this study were recruited for this study. The results showed that our model fitted the data very well and reveal that perceived social support partially mediates the relationship between resilience, PTSD severity, and PTG.

Loneliness Among Persons With Severe Mental Illness
Jonathan D. Prince, PhD, Adashima Oyo, MPH, Olivia Mora, MSW, Katarzyna Wyka, PhD, and Andrew D. Schonebaum, MA, LMSW

Using data on 150 people with SMI, we used logistic regression to predict (1) loneliness from sociodemographic and clinical characteristics, and (2) psychiatric hospitalization from presence of loneliness. Study participants who were most willing to ask for help were 70% less likely to be lonely than those who were least willing, and participants with high levels of internalized stigma were 9.25 times as likely as other participants to be lonely. Participants who were most lonely were 2.69 times as likely to be placed in psychiatric hospitals as those who were less lonely.

A Patient-Centered Antipsychotic Medication Adherence Intervention: Results From a Randomized Controlled Trial
Jeffrey M. Pyne, MD, Ellen P. Fischer, PhD, Dinesh Mittal, MD, and Richard Owen, MD

Data from 61 patients diagnosed with schizophrenia or schizoaffective disorder were analyzed. The intervention included a checklist of barriers, facilitators, and motivators (BFM) for taking antipsychotic medications. The results of the checklist were summarized, a note was placed in the electronic medical record (EMR), and a hard copy was given to the patient. However, less than half of the BFM progress notes were placed in the EMR before the clinician visit as planned. The intervention significantly improved adherence at 6 months, but not at 12 months, and the intervention's effect on total Positive and Negative Syndrome Scale scores was not statistically significant. The BFM intervention is promising, but future studies are needed to improve the integration of the BFM intervention into typical clinic workflow.

BRIEF REPORTS

Prevalence of Posttraumatic Stress Disorder in Patients With Multiple Sclerosis
Sara Carletto, PhD, Martina Borghi, PsyD, Francesco Scavelli, Diana Francone, PsyD, Maria Luisa Perucchini, Marco Cavallo, PhD, Francesco Pagnini, PhD, Antonio Bertolotto, MD, Francesco Oliva, MD, and Luca Ostacoli, MD

A total of 988 patients with MS were screened with the Impact of Event Scale–Revised, and then assessed with the PTSD module of the Structured Clinical Interview for DSM-IV and with the Clinician-Administered PTSD Scale to confirm PTSD diagnosis. Posttraumatic symptoms were reported by 25.5% of the sample. A confirmed diagnosis of PTSD was found in 5.7% of patients, but prevalence could reach 8.5%, including also dropout patients. Further studies are needed to evaluate if adjustment disorder could better encompass the frequently encountered subthreshold posttraumatic stress symptoms and how clinicians can deal with these symptoms with appropriate interventions.

Relationship Between the DSM-5 Anxious Distress Specifier and the Hamilton Depression Rating Scale Anxiety/Somatization Factor
Mark Zimmerman, MD, Heather Clark, BA, Patrick McGonigal, BA, Lauren Harris, BA, Carolina Guzman Holst, BS, and Jacob Martin, BA

We examined the association between the Hamilton Depression Scale (HAMD) approach to classifying depressed patients into anxious and nonanxious subgroups and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxious distress specifier subtyping. Two hundred and two depressed patients were interviewed with semistructured diagnostic interviews. Patients were rated on the 17-item HAMD and the Hamilton Anxiety Rating Scale and completed the Clinically Useful Anxiety Outcome Scale. Both approaches toward identifying anxiety in depressed patients resulted in most of the patients meeting the anxiety subtype. Both subtyping methods were significantly correlated with clinician-rated and self-report measures of anxiety, and scores on the anxiety scales were higher in the patients who met the anxious subtype. However, DSM-5 anxious distress subtyping was only marginally associated with the HAMD anxiety/somatization factor subtyping approach (k = 0.21), and dimensional scores were only moderately correlated (r = 0.50).

Differences in Mental Health Service Use Among Unemployed Veterans of Different Eras​
Debra S. Levine, PhD, Marcia Valenstein, MD, Matheos Yosef, PhD, Shahrzad Mavandadi, PhD, David W. Oslin, MD, Joseph A. Himle, PhD, and Kara Zivin, PhD

This study compared mental health treatment among unemployed Operation Enduring Freedom (OEF; in Afghanistan) and Operation Iraqi Freedom (OIF; in Iraq) veterans and veterans from other service eras. The study included 3165 unemployed veterans from six Veterans Affairs medical centers with a positive screen that indicates a possible mental disorder. Chi-squared tests and logistic regression analyses assessed whether veteran era was associated with mental health treatment. Unemployed OEF/OIF veterans were less likely to receive psychotropic medication and four or more psychotherapy sessions compared to veterans from other eras. Multivariable analyses controlling for age found associations based on younger age rather than era. Younger unemployed veterans received fewer mental health services, which is concerning because reducing mental health symptoms may increase employment and employment may reduce symptoms, which are key factors in reintegration into civilian life.

 

 


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