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Anhedonia is a transdiagnostic psychopathological phenomenon that is considered a key feature for several disorders, primarily affective spectrum disorders. It exhibits a significant association with social and occupational maladjustment, reduced quality of life, and increased suicidal risk among psychiatric patients.
Objectives
The aim of this study is to identify recommendations for psychotherapeutic assistance for patients with affective spectrum disorders.
Methods
A total of 26 patients with affective spectrum disorders (ICD-10 code - F33, F31) and the phenomenon of anhedonia were examined. We utilized neuropsychological methods aimed at investigating a wide range of cognitive functions (Dynamic praxis; Color interference test; Arithmetic Tasks; Number of skips and impulsive errors; Reverse and straight rows; Verbal fluency; Design fluency; Rey-Osterritz figure) and psychometric methods designed to diagnose various types of anhedonia (consummatory (TEPS), anticipatory (TEPS), social (RSAS), and physical (PAS)).
Results
Among patients with depression, the consummatory type of anhedonia was the most pronounced. A relationship was found between anticipatory anhedonia and phonetic verbal fluency (r = 0.487; p < 0.01). Additionally, there were correlations between immediate (consummatory) pleasure experience and Rey figure errors (r = -0.349; p < 0.05). Social anhedonia was associated with phonetic verbal fluency productivity (r = -0.509; p < 0.01) and performance in visual fluency productivity (r = -0.473; p < 0.01).
Conclusions
The obtained results allow us to hypothesize that anhedonia is associated with difficulties both in evaluating and imagining possible positive stimuli, which leads to a lack of emotional response to the current stimulus. Thus, the availability of current pleasure may be linked to memory accessibility and regulatory function. When these domains are weakened, the respondent loses the ability to associate the current stimulus with positive past experiences, making it challenging to generate an emotional response in the current stimulus situation and disrupting the anticipation of pleasure. Based on the results, we propose the effective use of behavioral activation and work on the actualization of past experiences. Behavioral activation can be implemented by gradually introducing behaviors associated with past pleasures into the patient’s life, followed by cognitive restructuring aimed at focusing the emotional response on past and current stimuli. In addition to this, from a neurocognitive perspective, an additional element of therapy could involve training various types of cognitive functions, with an emphasis on the auditory modality.
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
Methods
The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
Results
About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
Conclusions
The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
Anhedonia is a transdiagnostic psychopathological phenomenon, which is assessed as «core» for several diseases, first of all - schizophrenic and affective spectrum disorders. The problem of clinical features differentiation and identification of anhedonia’s neurobiological mechanisms in the structure of the affective and schizophrenic spectrum disorders is still topical and far from being resolved.
Objectives
The aim of the study was comparative research of the relationship between the features of neurocognitive functioning and the manifestations of anhedonia among patients with disorders of the schizophrenic and affective spectra.
Methods
The sample consisted of 40 patients, 17 patients with schizophrenic spectrum disorders and 23 patients with affective spectrum disorders were examined. We used next psychometric techniques to research anhedonia: Revised Social Anhedonia Scale (RSAS), The Temporal Experience of Pleasure Scale (TEPS), Physical Anhedonia Scale (PAS). We used following methods to study neuropsychological features: Dynamic praxis; Color interference test; Arithmetic Tasks; Plot picture; Number of skips and impulsive errors; Reverse and straight rows; Verbal fluency; Number of repetitions; Rey-Osterritz figure.
Results
Patients with schizophrenia spectrum disorders show lower scores of pleasure anticipation ability and ability to experience pleasure in the social sphere. Neuropsychological indicators of prefrontal cortex dysfunction demonstrate a positive relationship (p = 0.035) with the severity of social anhedonia and a negative relationship with the ability to anticipate pleasure. Thalamus and forehead dysfunction indicators mainly show a negative relationship with the ability to directly experience pleasure. Indicators of dysfunction of the parietal, occipital and temporal lobes have single connections with different parameters of anhedonia.
Conclusions
Manifestations of different parameters of anhedonia demonstrate their heterogeneity among patients with schizophrenic and affective spectrum disorders. Patients with schizophrenic spectrum disorders have greater difficulty with anticipation of pleasure and the ability to experience pleasure in the social sphere. The ability to anticipate pleasure is more strongly related to prefrontal brain function, whereas the ability to experience pleasure directly is related to subcortical brain function.
Harmful alcohol use far exceeds other mental disorders in the proportion of patients who do not receive adequate treatment. Despite the long history of anti-alcohol treatment in Czech Republic, there is no published prospective study to this day, in which patients that underwent inpatient addiction treatment are compared to patients on the waiting list and only one prospective randomized study comparing two different medium-term inpatient programs was published.
Almost all the studies published so far only bring results of particular hospitals. Differences in methodology, differences between cohorts of patients, absence of profiling and differences in therapeutic programs and historical changes makes comparison of results of those studies very difficult.
Objectives
This work seeks to present and compare the data from studies that evaluate the success of medium-term inpatient treatment of alcohol dependent patients in the Czech Republic. Another aim was to identify problems that make such comparison difficult.
Methods
Bibliographia Medica Čechoslovaca and Pubmed was used to find studies published in professional medical journals since 1970, in which abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence is evaluated.
Results
Medium-term inpatient treatment of alcohol addiction leads to one year abstinence in 34 to 76 % of patients. Such variance value is largely caused by different methodology of compared studies. In compared studies there are differences:
1. in definition of abstinence
2. if abstinence rate is assessed in all patients who have entered the treatment or only in those who have completed the treatment properly
3. if abstinence rate is calculated using number of patients entering treatment or the number of patients who have been obtained by valid information (outpatient clinic, questionnaires)
4. in the way the data was collected
5. in the composition of patients
6. in societal background, because there is large time gap present between compared studies
Conclusions
The comparison of individual studies presented many problems. Further steps should be taken to help compare treatment programs in the future, as they provide different therapeutic interventions in different intensity and length to different patients. Adequate patient profiling, detailed description of therapeutic interventions and identification of effective components of the therapeutic program is a way to support further research in this area, optimize existing programs and increase the overall efficiency of treatment.
The phenomenon of burnout generates the most interest due to relation to complete or partial disengagement of emotions, cognitive impairment, impairment of long-term and working memory. The neurophysiological mechanisms of emotional burnout remain insufficiently studied. Data related to gender specific characteristics of burnout formation are contradictory.
Objectives
To establish the gender related EEG markers of burnout was our aim.
Methods
621 volunteers (443 females) aged 18 to 24 years participated in this study. EEG was registered during the resting state (3 min, closed eyes condition). The interhemispheric and intrahemispheric average coherence across all EEG segments in all frequencies from 0.2-45 Hz was estimated. Psychological testing was performed before the registration of EEG. To determine the level of burnout formation the Boyko`s Syndrome of Emotional Burnout Inventory (SEB) was used.
Results
The Resistance phase of emotional burnout was formed in 139 women and 42 men. Development of Resistance stage in female includes formation of new intrahemispheric connections predominantly in the left frontal region (alpha1,2,3-subbands) and the midline frontal-central axis (Fz-Cz, alpha1,2 and theta2-subbands). At the same time new intrahemispheric links in men under Resistance stage development are formed mainly in the right frontal region (alpha1,2,3-subbands).
Conclusions
Connectivity patterns displayed gender-related variations that are associated with the difference in the alterations in the attention focusing, working memory, and emotional processes under burnout formation.
We propose the techniques for automatic processing of measurement results in the context of golden (typical) device selection and noise figure measurement. These techniques are for golden (typical) device selection and noise figure measurement processing. Automation of measurement result processing and microwave element modeling speeds up a modeling routine and decreases the risk of possible errors. The techniques are validated through modeling of 0.15 μm GaAs pHEMTs with 4 × 40 μm and 4 × 75 μm total gate widths. Two test amplifiers were designed using the developed models. The amplifier modeling results agree well with measurements which confirms the validity of the proposed techniques. The proposed algorithm is potentially applicable to other circuit types (switches, digital, power amplifiers, mixers, oscillators, etc.) but may require different settings in those cases. However, in the presented work, we validated the algorithm for the linear and low-noise amplifiers only.
During the Early Ordovician Epoch, the Mediterranean brachiopod Province was extensive in the higher-latitude sectors of the globe in the Southern Hemisphere. The latter was much occupied by the massive continent of Gondwana, which stretched from north of the Equator S-wards to cover the South Pole. The Mediterranean Province can be separated into two groups: Group 1, the higher-latitude fauna dominated by large linguliform brachiopods; and Group 2, which is more diverse, particularly in orthides. The large linguliform brachiopod faunas are particularly well known in southern Europe (France, Spain and Bohemia) and North Africa, and the second group in Avalonia, Chile and Argentina. The province is different from, but merges with, more diverse contemporary faunas in the lower latitudes of Gondwana to its north, although the latter contrast with other lower-latitude faunal provinces in South China, Laurentia, Siberia and elsewhere. Since the Rheic Ocean between Avalonia and Gondwana was relatively narrow during the Early Ordovician Epoch, the Avalonian brachiopods were integral parts of the Mediterranean Province, but only until end of the Dapingian Age. This paper focuses on the earlier phases of the Mediterranean Province, although the province continued until near the end of the Ordovician Period. Intermediate-latitude Baltica and some other faunas are included in new principal components and other analyses in order to compare them with the Mediterranean Province faunas. Radiation was very significant for many brachiopod taxa during the period, with first appearances of the Plectambonitoidea (Taffiidae), several orthide families (Euorthisinidae, Tarfayidae and Anamalorthidae) and the earliest endopunctate orthide, the dalmanelloid Lipanorthis.
Despite innovative treatments, the impairment in real-life functioning in subjects with schizophrenia (SCZ) remains an unmet need in the care of these patients. Recently, real-life functioning in SCZ was associated with abnormalities in different electrophysiological indices. It is still not clear whether this relationship is mediated by other variables, and how the combination of different EEG abnormalities influences the complex outcome of schizophrenia.
Objectives
The purpose of the study was to find EEG patterns which can predict the outcome of schizophrenia and identify recovered patients.
Methods
Illness-related and functioning-related variables were measured in 61 SCZ at baseline and after four-years follow-up. EEGs were recorded at the baseline in resting-state condition and during two auditory tasks. We performed Sparse Partial Least Square (SPLS) Regression, using EEG features, age and illness duration to predict clinical and functional features at baseline and follow up. Through a Linear Support Vector Machine (Linear SVM) we used electrophysiological and clinical scores derived from SPLS regression, in order to classify recovered patients at follow-up.
Results
We found one significant latent variable (p<0.01) capturing correlations between independent and dependent variables at follow-up (RHO=0.56). Among individual predictors, age and illness-duration showed the highest scores; however, the score for the combination of the EEG features was higher than all other predictors. Within dependent variables, negative symptoms showed the strongest correlation with predictors. Scores resulting from SPLS Regression classified recovered patients with 90.1% of accuracy.
Conclusions
A combination of electrophysiological markers, age and illness-duration might predict clinical and functional outcome of schizophrenia after 4 years of follow-up.
According to a selective meta-analytical review, weakness of working memory is considered as one of the fundamental disorders in schizophrenia. Some researchers propose identifying this disorder as an endophenotypic marker of schizophrenia diathesis. Many researchers also emphasize violations of “abstract thinking”, that is, the ability of patients to operate with abstract concepts. Many scientists understand the violation of “abstract thinking” as the difficulty of patient in operating with the dominant signs of the concept. Based on these approaches, we assume a dark relationship between working memory and abstract thinking.
Objectives
The aim of this study is to investigate the relationship between working memory and abstract thinking defect in patients with schizophrenic spectrum disorders.
Methods
16 patients with schizophrenic spectrum disorders were studied. To study abstract thinking, the following neuropsychological and psychometric techniques were used: exclusion of objects, D-KEFS understanding of proverbs (latent concepts were recorded). The following techniques were used to study working memory: n-back; Wechsler Test, subtest Digit Repetition.
Results
As a result of preliminary research, the following data was obtained. We found significant differences between the number of irrelevant features (which corresponds to impaired abstract thinking) and the severity of impaired working memory (p = 0.035). The more the memory was impaired, the more the subjects demonstrated the impairment of abstract thinking.
Conclusions
Thus, our results justify our assumption. A relationship between working memory and abstract thinking is founded to be possible. Further studies of this issue requires a wider techniques battery as well as a larger sample.
Conflict of interest
The reported study was funded by RFBR, project number 20-013-00772
Childhood trauma (CT) is associated with an increased risk of mental health disorders; however, it is unknown whether this represents a diagnosis-specific risk factor for specific psychopathology mediated by structural brain changes. Our aim was to explore whether (i) a predictive CT pattern for transdiagnostic psychopathology exists, and whether (ii) CT can differentiate between distinct diagnosis-dependent psychopathology. Furthermore, we aimed to identify the association between CT, psychopathology and brain structure.
Methods
We used multivariate pattern analysis in data from 643 participants of the Personalised Prognostic Tools for Early Psychosis Management study (PRONIA), including healthy controls (HC), recent onset psychosis (ROP), recent onset depression (ROD), and patients clinically at high-risk for psychosis (CHR). Participants completed structured interviews and self-report measures including the Childhood Trauma Questionnaire, SCID diagnostic interview, BDI-II, PANSS, Schizophrenia Proneness Instrument, Structured Interview for Prodromal Symptoms and structural MRI, analyzed by voxel-based morphometry.
Results
(i) Patients and HC could be distinguished by their CT pattern with a reasonable precision [balanced accuracy of 71.2% (sensitivity = 72.1%, specificity = 70.4%, p ≤ 0.001]. (ii) Subdomains ‘emotional neglect’ and ‘emotional abuse’ were most predictive for CHR and ROP, while in ROD ‘physical abuse’ and ‘sexual abuse’ were most important. The CT pattern was significantly associated with the severity of depressive symptoms in ROD, ROP, and CHR, as well as with the PANSS total and negative domain scores in the CHR patients. No associations between group-separating CT patterns and brain structure were found.
Conclusions
These results indicate that CT poses a transdiagnostic risk factor for mental health disorders, possibly related to depressive symptoms. While differences in the quality of CT exposure exist, diagnostic differentiation was not possible suggesting a multi-factorial pathogenesis.
Disulfiram is an aversive medication that works by making the drinking of alcohol an unpleasant experience (FDA approved since 1951) and most study of understanding alcohol abuse and dependence are based on it. Also, the combined Cognitive Behavioral Therapy (CBT) and disulfiram assurance treatment was substantially effective in patients with alcohol disorders.
Methods
We conducted 150 male patients range of age 20-60 and treated in Special Hospital on Addictions for 3 months period of time (inpatient setting).The recommended dose of disulfiram was 250 mg. All patients were diagnosis of alcohol dependence according the ICD-X, excluded psychosis and no one was unable to take disulfiram for medical reason. We used medical history of illness, psychiatric interview and semi structured CBT protocol for alcohol disorder and CBT sessions (2 sessions per week). Control group were 80 patients on disulfiram assurance therapy (alone).
Results
CBT plus disulfiram assurance (N=150): 93(62%) maintaining sobriety and absence of drinking for 3 months; 44 (29,33%) maintaining sobriety for 2 months and 13 (8,66%) absence of drinking only 1 - 1,5 month.Disulfiram assurance therapy alone (control group) (N=80): 41 (51,25%) maintaining sobriety of drinking for 3 months; 22 (27,5%) less than 3 months; 10 (12,5%) for 1,5 - 2 months and 7 patients (8,75%) drop-out after a week without no relevant or medical reasons.
Conclusions
In this paper was shown the high level of effectiveness for the CBT combined with disulfiram assurance therapy according the maintaining sobriety and absence of drinking.
Present study focuses on metabolic and neuroendocrinologic effects of long-acting injectable risperidone (LAIR) treatment in a naturalistic sample of patients with schizophrenia spectrum disorders.
Method
Twenty three outpatients with schizophrenia or schizoaffective disorder (ICD X) (age 32.3±6.5years, illness duration 8.7±5.1 years, PANSS 78.1±14.7) were included. At the time of evaluation the patients were treated with LAIR for 1.4±0.7 years, average dose 38.6±9.9mg. Total duration of antipsychotic therapy was 8.0±4.8 years. Control group (n=23) were healthy volunteers matched by age, sex and education.In the morning serum we measured leptin, prolactin, cortizol, IGF1, T4, FSH, LH, HbA1c, total cholesterol, HDL, LDL and triglicerides. Both groups were tested by oral glucose load (OGTT), with measuring insulin levels and anthropometric parameters.
Results
In comparison to control group, the patients had higher BMI (p< .001), waist circumference (WC, p=.004), increased leptin (p=.013), prolactin (p< .001), triglycerides (p=.029) and fasting glucose (p=.004). After controlling for BMI, WC and sex, only prolactin (p< .001, ηp2= .50) and leptin (p=.040, ηp2=.13) were significantly increased in the patient group.
Conclusion
This is the first study of LRAI effects on metabolic and neuroendocrine parameters. Our cross-sectional study has shown that the most consistent side effects of LAIR were increased prolactin and leptin, while other deviations might be attributed to confounding covariates. Whether pharmacokinetic and pharmacodynamic advantages of LAIR over oral drug formulation are accompanied with favorable metabolic and neuroendocrine profile remains to be assessed by head to head studies.
Funding
This study was supported by a grant from the Ministry of Science, Republic of Serbia (Project 145019).
Traumatic brain injury (TBI) is recently recognized as a risk factor for hypopituitarism, presented most frequently with growth hormone deficiency (GHD). GHD is associated not only with changes in body composition, but also with impaired quality of life, cognitive dysfunctions and some psychiatric sequelae, usually classified as “depression” or “atypical depression”. The impact of GH therapy on mental status is still unknown.
Design
Psychiatric and cognitive functions were tested in six adult GHD subjects at baseline (minimum three years after TBI), reassessed after six months of GH replacement therapy as well as twelve months after discontinuation of GH therapy. Psychiatric and cognitive examinations included semi-structured interviews and three instruments: Symptom-checklist (SCL-90-R), Zung Depression Inventory and standard composite neuropsychological battery.
Results
Six months of GH therapy in GHD TBI patients improved cognitive abilities (particularly verbal and nonverbal memory) and improved psychiatric functioning. Severity of depression decreased, as well as intensity of interpersonal sensitivity, hostility, paranoid ideation, anxiety and psychoticism. In three GHD patients who stopped GH therapy for twelve months we registered worsening of the verbal and nonverbal memory, as well as increase in Zung score and three SCL dimensions: inter-personal sensitivity, anxiety and paranoid ideation.
Conclusion
This preliminary data suggest that GH therapy induced reduction of depression, social dysfunction and improvement in certain cognitive domains in GHD patients after TBI. Our data support the necessity of conducting randomized placebo-controlled trials on the effects of GH therapy on neuropsychological and psychiatric status in GHD TBI patients.
It has been shown that abusive experiences in childhood may be related to specific behavior patterns manifested in adulthood, especially those that refer to negative parenting practices. The aim of this study was to assess the relationship between the use of punitive parental discipline and the childhood abuse trauma in parents.
Method:
Sixty six parents (30 males, 36 females, age 45.92±8.79 yrs, predominantly urban) completed the socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), and the punitive discipline self-report measure.
Results:
The frequency of use of punitive discipline between parents with and without the history of abuse was not significantly different (t=-1.298; p>0.05). The difference was not found neither among fathers (t=-0.047; p>0.05) nor among mothers (t=-1.951; p>0.05). Emotional abuse was the only type of childhood maltreatment related to the use of punitive discipline (r=0.393; p< 0.01). This relationship was found among both fathers (r=0.428; p< 0.05) and mothers (r=0.371; p< 0.05). In females, the use of punitive discipline was additionally related to the history of emotional neglect (r=0.379; p< 0.05).
Conclusion:
The findings may emphasize the need for identification and modification of the parental discipline strategies in adult victims of child emotional abuse and neglect.