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March 2020 - Volume 208 - Issue 3

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • Psychiatry 97/146; Clinical Neurology 145/199
  • 1.859


The Relationship Between Medication Attitudes and Medication Adherence Behavior in Adults With Bipolar Disorder
Jennifer B. Levin, PhD, Michelle E. Aebi, MA, Molly Howland, MD, Marina Barboza, MA, Logan Eskew, MA, Curtis Tatsuoka, PhD, Kristin A. Cassidy, MA, Martha Sajatovic, MD

This study examined the psychometric properties of the Attitudes Toward Mood Stabilizers Questionnaire (AMSQ) in bipolar participants and the relationship between medication attitudes and adherence, measured by the self-reported Tablets Routine Questionnaire (TRQ). Inclusion criteria included mood stabilizer treatment and 20% or more medication nonadherence. Measures were given pretreatment and posttreatment. Average age was 47 years; majority were female (69%), African American (67%), and unmarried (53%). AMSQ's test-retest reliability was ρ = 0.73 (p < 0.001). AMSQ correlated with TRQ (rs = 0.20, p < 0.01) at baseline. Factor analysis identified three factors: positive/favorable attitudes, negative/critical attitudes, and unintentional nonadherence. Change in AMSQ across time correlated with change in TRQ. The AMSQ is valid psychometrically and is sensitive to change. Medication attitudes are related to adherence behavior. Interventions should include targeting specific domains of medication attitudes, such as illness knowledge.

On the Continuity Between Autistic and Schizoid Personality Disorder Trait Burden: A Prospective Study in Adolescence
Michal Lauren Cook, MSW, Yi Zhang, MS, and John N. Constantino, MD

Although widely conceived as distinct conditions, higher-functioning autism spectrum disorder (ASD) and schizoid personality disorder (schizoid PD) share similar clinical symptomatology. This study explored the relationship between the two disorders by collecting extensively validated measures of autistic trait burden and schizoid PD affectation from clinically ascertained verbal males with and without autism ages 12 to 25 years (N = 72) via parent, teacher, and self-report. Although only a small minority of adolescents with ASD met full diagnostic criteria for schizoid PD, participants with ASD endorsed a continuous distribution of schizoid PD traits that reflected a pronounced pathological shift in comparison with those in the control group, with one half of ASD males experiencing three or more Diagnostic and Statistical Manual of Mental Disorders, 4th Edition schizoid PD criterion items "often" or "almost always." Results suggest significant amplification of schizoid PD trait burden in adolescents with ASD.

Preventing Postpartum Depression With Mindful Self-Compassion Intervention: A Randomized Control Study
Lu Guo, MD, Jing Zhang, MD, Liping Mu, MD, and Zhao Ye, MD

We aimed to assess the effect of mindful self-compassion intervention on preventing postpartum depression in a group of symptomatic pregnant women. Participants were screened and assigned to the intervention and control groups randomly. A 6-week Internet-based Mindful Self-Compassion Program was used to train the participants. Multiple scales were used to assess depressive and anxiety symptoms, mindfulness, self-compassion, and mother and infant well-being. All assessments were performed at three time points: baseline, 3 months, and 1-year postpartum. Compared with the control group, the intervention group showed significant improvement in depressive and anxiety behaviors. The intervention group became more mindful and self-compassionate at 3 months and 1-year postpartum. More importantly, both mothers and infants experienced substantial improvement in well-being.

DSM-5 Personality Disorders and Traits in Patients with Severe Health Anxiety
Mathias Skjernov, MD, PhD, Bo Bach, MSc, PhD, Per Fink, MD, PhD, DMSc, Brian Fallon, MD, MPH, Ulf Soegaard, MD, and Erik Simonsen, MD, PhD

Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84). There were 71.4% of the patients who met criteria for PDs: avoidant (22.6%), obsessive-compulsive (16.7%), depressive (16.7%), dependent (7.1%), paranoid (3.6%), borderline (2.4%), and not otherwise specified (32.1%). Severity of personality pathology was associated with severity of health anxiety. In group comparisons, PID-5 trait domains of negative affectivity, detachment, low antagonism, and low disinhibition, and facets of anxiousness, separation insecurity, and low attention seeking emerged as unique predictors of SHA. Further research is needed to understand the nature of the relationship between health anxiety and personality pathology and to determine whether treatments that target both SHA/HYand personality pathology will improve short- and long-term outcomes.

Toxoplasmosis in a Cohort of Italian Patients with Bipolar and Psychotic Disorders: How Infection May Affect Clinical Features
Claudia Del Grande, MD, Elisa Schiavi, MD, Isabella Masci, MD, Margherita Barbuti, MD, Giuseppe Maccariello, MD, GabrieleMassimetti, Dr Sci, FabrizioBruschi, MD, and Liliana Dell'Osso, MD, PhD

This study investigated the seroprevalence of Toxoplasma gondii in a cohort of 101 Italian inpatients affected by mood or schizophrenia-spectrum disorders and compared clinical features between seronegative and seropositive subjects. Patients underwent clinical assessments and blood collection to test parasite-specific IgG/IgM serum levels. Twenty-eight patients (27.7%) had IgG anti–T. gondii, and none had IgM antibodies. We found higher prevalence rate in patients aged 40 years or older, as compared with younger. No significant association was detected between T. gondii and a specific diagnostic category; however, bipolar disorder (BD)-II showed the highest positivity rate (40.9%). The seropositive status was significantly associated with a lower presence of psychotic symptoms, higher number of total episodes of predominant excitatory polarity, longer illness duration, and lower severity of current episode -- particularly anxiety, depressive, and withdrawal/retardation symptoms.

Pharmacogenomic Testing in Psychiatry: Ready for Primetime?
Gopalkumar Rakesh, MD, Calvin R. Sumner, MD, Jeanne Leventhal Alexander, MD, ABPN, FRCPC, FAPA, FACPsych, Lawrence S. Gross, MD, Janet Pine, MD, Andrew Slaby, MD, Amir Garakani, MD, and David Baron, MSEd, DO

We intend this article to be a primer for a clinician wishing to understand the biological bases, evidence for benefits, and pitfalls in clinical decision-making. Using clinical vignettes, we elucidate these headings in addition to providing a perspective on current relevance, what can be communicated to patients, and future research directions. Overall, the evidence for pharmacogenomic testing in psychiatry demonstrates strong analytical validity, modest clinical validity, and virtually no evidence to support clinical use. There is definitely a need for more double-blinded randomized controlled trials to assess the use of pharmacogenomic testing in clinical decision making and care; and until this is done, they could perhaps have an adjunct role in clinical decision-making, but minimal use in leading the initial treatment plan.

Family Functioning and Suicide Among the Elderly in Rural China: A Case-Control Psychological Autopsy Study
Yan-Xin Wei,MB, Bao-Peng Liu,MPH, Zhen-YuMa, PhD, Liang Zhou, MD, and Cun-Xian Jia, PhD

This 1:1 paired case control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency.  Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China.

Metacognitive Capacity Is Related to Self-Reported Social Functioning and May Moderate the Effects of Symptoms on Interpersonal Behavior
Melanie W. Fischer, MA, MS, Giancarlo Dimaggio, MD, Jesse Hochheiser, MA, Jenifer L. Vohs, PhD, Peter Phalen, PsyD, and Paul H. Lysaker, PhD

This study examined whether self-reported social functioning was related to metacognition in 88 adults in a nonacute phase of schizophrenia. Concurrent assessments were made of metacognition with the Metacognition Assessment ScaleAbbreviated, social functioning with the Social Functioning Scale, symptoms with the Positive and Negative Syndrome Scale, and neurocognition with the Wisconsin Card Sorting Task. Univariate correlations revealed that self-reported social functioning was related to metacognition. Symptom severity was linked to interpersonal relationships, and overall metacognition was found to significantly moderate that relationship such that the effects of symptoms on function grew less as metacognitive capacity was stronger, independent of the effects of neurocognition. This may suggest the potential of metacognitive interventions to titrate the negative effects of symptoms on social function.

Sociodemographic Characteristics Associated with Speech and Language Delay and Disorders
Ayla Uzun Çiçek, MD, Emrah Akdag, PsyD, and Ozlem Celebi Erdivanli, MD

Two hundred twenty-eight children (aged 24–72 months) with speech and language delay/disorders participated in this study. The Ankara Developmental Screening Inventory and The Peabody Picture Vocabulary Test were used to assess language profiles and developmental stages of children. Low income, nonattendance in preschool education, low maternal education, having two or more siblings, later birth order (order of siblings), family history of speech and language delay/disorders, preterm birth, low birth weight, and birth complications or the need for intensive care support during neonatal period were identified as risk factors (all p < 0.005). Both sociodemographic and biologic factors were associated with speech and language delay/disorders. Awareness of these factors may provide a chance for earlier diagnosis and intervention.

Increased Psychiatric Risk in Children After Pediatric Intensive Care Unit Admission
Hanaa I. Rady, MD, Omnia Raafat Ismail, MD, Mohammed Safwat Abdelkader, MBBCH, and Abobakr Abosree Abdelgalil, MD

We examined 130 children aged 6 to 13 years in a cross-sectional study divided into two groups: 65 children discharged from PICU and another 65 from general wards. The PICU group scored worse on all measured scales of psychiatric morbidities. The child-specific assessment methods included the posttraumatic stress disorder (PTSD) scale as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and Impact of Event Scale Revised for PTSD; Revised Children's Manifest Anxiety Scale for anxiety; and Birleson Depression Scale for depression. The PICU group had significantly higher frequencies of PTSD compared with the general ward group (84.6% vs. 6.2%, respectively; p < 0.001). Hence, PICU survivors have higher risk of psychiatric morbidities such as PTSD, anxiety, and depression compared with general ward patients.

2019 Reviewer Acknowledgment

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