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October 2019 - Volume 207 - Issue 10

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


Total and Differential White Blood Cell Counts, Cocaine, and Marijuana Use in Patients With Schizophrenia
Ryan L. Goetz, BSc, and Brian J. Miller, MD, PhD, MPH

We examined effects of marijuana and cocaine use on white blood cell (WBC) counts in acutely ill, hospitalized patients with schizophrenia, using a within-subjects and between-groups design. Mean total and differential WBC counts were first compared in acutely ill patients with schizophrenia for hospitalizations with and without either marijuana (n = 18) or cocaine (n = 24) use. Mean total and differential WBC counts were then compared between patients with schizophrenia with either marijuana or cocaine use and patients with a negative urine drug screen (UDS; n = 43). Patients with schizophrenia had significantly higher total WBC, lymphocytes, and monocytes during hospitalizations with (vs. without) cocaine use. Patients with cocaine use also had significantly higher monocytes and eosinophils than those with a negative UDS. Our findings suggest that substance use, particularly of cocaine, may modulate inflammatory marker levels in acutely ill, hospitalized patients with schizophrenia.

Investigating the Relationship Between Weight-Related Self-Stigma and Mental Health for Overweight/Obese Children in Hong Kong
Ka Lam Chan, BSc, Clara S.C. Lee, OT(C), PhD, Cho Man Cheng, BSc, Lok Yiu Hui, BSc, Wan Tung So, BSc, Tik Shun Yu, BSc, and Chung-Ying Lin, OT/L, PhD

Children ages 8 to 12 years (n = 367; 198 boys) completed questionnaires on weight-related self-stigma and mental health conditions. Compared with non-overweight (OW) children (n = 241; 143 boys), OW children (n = 114; 55 boys) had higher weight-related self-stigma in the WBIS (26.49 ± 8.68 vs. 21.58 ± 7.54; p < 0.001) and WSSQ scores (26.36 ± 8.98 vs. 21.91 ± 8.71; p < 0.001). No significant difference was found between OW and non-OW children in mental health conditions as reflected by the BSRS-5 score (4.29 ± 4.35 vs. 4.44 ± 4.16; p = 0.761). OW children tended to have a higher level of self-stigma; those having a higher level of weight-related self-stigma presented with more mental health problems.

Daily Functioning in Schizophrenia: Is There Room for Anxiety?
Mariachiara Buonocore, PSY,  Francesca Bosinelli, PSY, Margherita Bechi, PSY, Marco Spangaro, MD, Federica Cocchi, MD, Laura Bianchi, MD, Carmelo Guglielmino, MD, Maria Alice Baraldi, PSY, Lavinia Anchora, PSY, Serena Bringheli, PSY, Roberto Cavallaro, MD, Marta Bosia, PhD

One hundred five patients with DSM-IV-TR schizophrenia were recruited and underwent a broad functional, psychopathological, and clinical-neuropsychological battery. A forward stepwise regression model was used to assess the predictive effect of anxiety and other factors on daily functioning, showing significant results only for global neurocognitive status and anxiety. These results confirm the role of neurocognition and are also in line with the hypothesis that trait anxiety has a direct impact on functional outcome.

Burnout and Its Relationships With Alexithymia, Stress, Self-Esteem, Depression, Alcohol Use Disorders, and Emotional Intelligence: Results From a Lebanese Cross-Sectional Study
Nathalie Lahoud, PharmD, MPH, PhD,  Maha Zakhour, PhD,  Chadia Haddad, MPH, Pascale Salameh, PharmD, MPH, PhD, Marwan Akel, PharmD, MPH,  Kassandra Fares, MSc,  Souheil Hallit, PharmD, MSc, MPH, PhD,  Sahar Obeid, PhD

Our aim was to assess the relationship between personality and psychological traits, and burnout among the Lebanese population. The study, conducted between November 2017 and March 2018, enrolled 789 participants. The results showed that 100 (14.0%) had high emotional work fatigue, whereas 443 (62.5%) and 680 (95.4%) had high mental and physical work fatigue, respectively. People with high physical work fatigue (cluster 1) had lower alcohol dependence (β = −2.78), alexithymia (β = −3.16), depression (β = −7.20), anxiety (β = −6.99), perceived stress (β = −2.53), social phobia (β = −11.49), suicidal ideation (β = −0.35), emotional awareness (β = −4.54), emotional management (β = −1.71), social emotional awareness (β = −9.27), and relationship management (β = −9.12). People with high emotional work fatigue (cluster 2) had higher alcohol dependence (β = 2.11), alexithymia (β = 6.51), depression (β = 2.48), anxiety (β = 4.11), perceived stress (β = 4.30), and lower emotional awareness (β = −6.68), emotional management (β = −7.80), social emotional awareness (β = −3.71), and relationship management (β = −3.05). Higher levels of burnout were found to be associated with multiple psychological factors.

Heart-Focused Anxiety Among Latinx in Primary Care: Relations to Anxiety, Depression, Pain, and Functional Impairment
Kara Manning, BS, Andrew H. Rogers, MA, Jafar Bakhshaie, MD, Andres G. Viana, PhD, ABPP, Chad Lemaire, MD, Monica Garza, PhD, MPH, Melissa Ochoa-Perez, MD, Michael J. Zvolensky, PhD

The current study sought to evaluate the potential explanatory relevance of heart-focused anxiety as an important individual difference factor for anxiety, depression, pain experience, and functional impairment. Participants included 158 Latinx adults (Male = 39.26, SD = 13.19; 85.4% female) from a primary health clinic. Results indicated that heart-focused anxiety was significantly related to anxious arousal, pain intensity, pain disability, and functional impairment. However, no significant effects were evident for depressive symptoms. These data indicate that heart-focused anxiety may be an underrecognized cognitive factor relevant to better understanding anxiety and pain among Latinx adults in primary care

Cognitive and Behavioral Differentiation of Those With Borderline Personality Disorder and Bipolar Disorder
Adam J. Bayes, MBBS (Hons), PhD, and Gordon B. Parker, MD, DSc, PhD

The current study sought to identify features offering differentiation of borderline personality disorder (BPD) from bipolar disorder (BP). A 113-item self-report questionnaire was completed, comprising cognitive and behavioral constructs weighted to a borderline personality style. A total of n = 53 participants were assigned to BPD, n = 83 to BP, with comorbid participants excluded. Twenty items were highly endorsed (>95%) by the BPD group, with most of the features capturing emotional dysregulation (ED) and identity disturbance; however, many items were also highly endorsed by the participants with BP. Thirty-eight items offered differentiation of BPD from BP, with identity disturbance overrepresented. The study findings indicate that the transdiagnostic nature of ED (a feature of both conditions) means it is less useful for diagnostic decisions, whereas identity disturbance is both intrinsic to BPD and offers specificity in differentiation from BP.

For Better or Worse: Facebook Use and Wellbeing Among Community Mental Health Care Clients 
Kathleen Kjelsaas, DCP, Naomi Mecklenburgh, Courtney von Hippel, PhD, Loren Brener, PhD

Twenty-six clients from a community mental health service provided access to their Facebook page. Seven aspects of 3,674 Facebook posts were coded, and cross-lagged multilevel models were estimated over three periods to establish the relationship between Facebook use and wellbeing over time. Some aspects of Facebook use were related to wellbeing within the same period, although this pattern of relationships did not emerge longitudinally. Although Facebook has the potential to forge social connections for those who are socially isolated, Facebook use was neither helpful nor harmful over time among people with mental health problems.

Association of Psychache and Alexithymia With Suicide in Patients With Schizophrenia
Mehmet Emin Demirkol, MD, Lut Tamam, MD,  Zeynep Namlı, MD,  Mahmut Onur Karaytuğ, MD, Kerim Uğur, MD

This study evaluated psychache and alexithymia in patients with schizophrenia, which have both been associated with suicide attempts and thoughts in patients with other psychiatric disorders. Positive and Negative Syndrome Scale (PANSS), Psychache Scale (PAS), Beck Scale for Suicidal Ideation (BSSI), Calgary Depression Scale for Schizophrenia (CDSS), and Toronto Alexithymia Scale (TAS) scores were obtained in 113 patients with schizophrenia, including 50 with suicide attempts. PANSS positive symptoms and general psychopathology subscale, CDSS, BSSI, TAS, and PAS scores were significantly higher in patients with suicide attempts. In multivariate logistic regression analysis, only the PAS score was an independent predictor of attempted suicide. Mediation analysis demonstrated that psychache (both directly and indirectly) and alexithymia (indirectly) might be associated with the risk of suicide in these patients.

Refining Psychological, Substance Use, and Sociodemographic Predictors of Suicide Ideation and Attempts in a National Multiethnic Sample of Adults, 2008–2013
Soumia Cheref, MA, Julia S. Benoit, PhD, Rheeda L. Walker, PhD

The purpose of this study was to examine psychological, substance use, and sociodemographic predictors of 12-month suicide ideation and attempts across six US racial/ethnic groups—white, Latino/a, Black, Asian or Pacific Islander (A/PI), American Indian or Alaska Native (AI/AN), and multiracial adults. Multiple logistic regression analyses were conducted for 218,765 adults who participated in the 2008–2013 National Survey on Drug Use and Health. As one example, 12-month depression was associated with 12-month suicide attempt for A/PI, AI/AN, Latino/a, and white, but not for Black or multiracial adults. Alcohol abuse and dependence were also associated with suicide attempt for AI/AN, Black, and white respondents but not for other racial/ethnic groups. Risk factors for suicide ideation and attempt may not increase risk universally.

The Mediating Role of Implicit and Explicit Emotion Regulation in the Relationship Between Academic Emotions and Approaches to Learning: Do Defense Styles Matter?
Christos Rentzios, PhD, Spiridon Kamtsios, PhD, Evangelia Karagiannopoulou

Participants were composed of 226 undergraduates (40 males and 186 females studying in a social science department). They completed the following questionnaires: Emotion Regulation Questionnaire, Student Experience of Emotions Inventory, Defense Style Questionnaire, and Approaches to Learning and Studying Inventory. Both the moderating (interaction) and the mediational (indirect) effects were examined using the PROCESS program. Results failed to indicate the moderating role of emotion regulation in the association between academic emotions and approaches to learning. Instead, results revealed the dominant mediating role of emotion regulation and particularly the role of immature defense style in the relationship between negative emotions and approaches to learning. Moreover, reappraisal and suppression seemed to act as mediators in the relationship between positive and negative emotions with deep and surface approaches, respectively.

A Randomized Controlled Trial Assessing the Efficacy of Group Psychological First Aid
Katie E. Despeaux, MS, Jeffrey M. Lating, PhD, George S. Everly, Jr, PhD, Martin F. Sherman, PhD, Matthew W. Kirkhart, PhD

A randomized controlled trial assessed the efficacy of group psychological first aid (PFA) by comparing the Johns Hopkins RAPID-PFA model with a group conversation condition in 119 participants, using the state version of State Trait Anxiety Scale and the Positive and Negative Affect Schedules. Both groups showed similar baseline scores, and after watching a distressing 5-minute video, both groups showed similar significant increases in state anxiety scores and negative affect scores, as well as similar decreases in positive affect scores. However, compared with the group conversation condition, the RAPID-PFA group evidenced significantly lower state anxiety scores at postintervention and at 30-minute delay. RAPID-PFA, compared with the group conversation condition, was also more effective in lowering negative affect scores postintervention, and significantly increasing positive affect scores at 30-minute delay. These results support the two primary goals of PFA, which are mitigating acute distress and instilling hope.

Home-Based Computerized Cognitive Training for Postoperative Cognitive Dysfunction After Lung Transplantation in Elderly Population: A Randomized Controlled Trial
Yanping Song, MM, Xueling Cui, BM, Yan Zhang, MM, Huiying Gao, BM, Qiaoying Cai, MM, Zhenzhen Mu, BM

Home-based computerized cognitive training (CCT) is a widely used intervention for cognition improvement, but its efficacy has not been validated in this population. A randomized controlled trial was conducted to analyze the effect of CCT on elderly lung transplant recipients. The participants received either an 8-week CCT intervention or usual care. The changes of cognitive function were assessed between preintervention (T1), postintervention (T2), and 12 weeks postintervention (T3). Among the 46 participants, 91.3% completed the interventions. The CCT group performed better than the control group on Digit-Span Forward Test (T3: p = 0.0044) and Verbal Fluency Test (T3: p = 0.0331), indicating the efficacy of CCT on verbal memory in the elderly lung transplant recipients. Although varied impacts were observed on different cognitive domains, it seems promising to use CCT on the elderly population after lung transplantation.

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