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Epilepsy care often intersects with mental health care. The chapter begins with nonepileptic events. This commonly encountered diagnosis is frequently on the differential for people with new onset seizures. Prompt recognition of a nonepileptic diagnosis can lead to early evidence-based treatment with cognitive behavioral therapy. Moreover, a nonepileptic event diagnosis can avoid inappropriate treatments such as antiseizure medicines (ASMs). It is critical to understand a nonepileptic event diagnosis does not mean that the events are not real or the patient is faking. Specific diagnostic clues for nonepileptic events are thoroughly discussed. The other section of the chapter explores the management of comorbid psychiatric diagnoses in patients with epilepsy and nonepileptic events. The use of most psychiatric medications, including stimulants, can be considered without affecting an epilepsy patient’s treatment plan. An understanding of psychiatric medication and ASM interaction can guide drug selection. As psychiatric diagnoses negatively affect epilepsy patients’ quality of life, prompt recognition and compassionate care can improve your patient’s overall health care.
The topic of mental health in female serial killers (FSKs) has been largely unexamined. It is plausible that many FSKs committed their crime before the introduction of standard diagnostic systems. The author’s team found that nearly 40% of FSKs in their study sample had a history of mental illness, including anxiety, depression, personality disorders, dissociative disorders, and factitious disorder imposed on another (FDIA), formerly called Munchausen syndrome by proxy (MSBP). This evidences that mental illness is overrepresented in FSKs compared to the population. Also in this chapter, the author reviews data on infrequent FSK mental health treatment, as well as on demeanor, sexual adjustment, and substance use. The author urges increased efforts for diagnosing and treating mental health issues to prevent murder. Case studies of FSKs Martha Woods and Marybeth Tinning illustrate mental health phenomena. The case of FSK Margie Barfield and a revisitation of the case of FSK Amy Archer-Gilligan illustrate substance abuse.
In this two-part study, we conducted both cross-sectional and longitudinal investigations on the relative weights of experiential, cognitive, and sociopsychological factors in adult L2 speech learning. In the cross-sectional phase (Study 1), speech was elicited from 73 Japanese speakers of English via a picture description task, and rated for accentedness and comprehensibility. These scores were linked to scores on a range of tests designed to measure aptitude, motivation, and anxiety. The results showed that comprehensibility was exclusively linked to experiential variables (e.g., the amount of L2 use outside classrooms), while accentedness was linked to phonemic coding ability and anxiety. In the longitudinal phase (Study 2), we tracked the same participants' L2 comprehensibility and accentedness development when they received four weeks of explicit pronunciation instruction. According to the results of pre- and post-tests, participants significantly improved the comprehensibility and accentedness of their speech regardless of cognitive and sociopsychological differences.
To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression.
Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The GAD-7 and PHQ-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations between food insecurity and related coping strategies, and anxiety and depression.
South Africa during COVID-19, October 2021.
Nationally representative sample of 3,402 adults, weighted to 39,640,674 South African households.
About 20.4% of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from “food secure” to “at risk” or from “at risk” to “food insecure” group was associated with 1.7 times greater odds of being in a higher category of anxiety or depression (p<0.001).
All coping strategies were used to some extent in South African households, with 46.0% relying on less preferred and less expensive foods, and 20.9% sending a household member to beg for food. These coping strategies were mostly used by food insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all p<0.001), begging for food was associated with the highest odds (odds ratio=2.3).
Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.
Individuals with gender dysphoria display an incongruence between birth-assigned gender and gender expression. However, there is no existing Chinese measure for gender dysphoria.
This study aims to validate the Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) in a Chinese population, and compare the psychometric properties of the UGDS-GS with one frequently used scale for gender dysphoria measurement, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA).
A total of 2646 Chinese participants were recruited. The following information was collected: sociodemographic variables, gender identity, sexual orientation, gender dysphoria measured by the UGDS-GS and the GIDYQ-AA, anxiety, depression and suicide assessment. Principal component analyses and confirmatory factor analysis (CFA) were conducted to test the fitness of the model. Discriminant validity was tested with one-way analysis of variance.
The UGDS-GS showed good psychometric properties, with the GIDYQ-AA demonstrating slightly better psychometric properties than the UGDS-GS. UGDS-GS also showed strong internal consistency (Cronbach's α = 0.89), and good convergent validity and criterion validity. Exploratory factor analysis showed a one-factor structure (Kaiser-Meyer-Olkin test, 0.93; χ2 = 13 342.50; d.f. = 153; P < 0.001). The UGDS-GS was positively associated with anxiety symptoms, depressive symptoms, suicidal ideation, attempted suicide and self-harm. We also found the results were robust in different samples.
The validated UGDS-GS can significantly stimulate and promote gender dysphoria assessment in Chinese populations, allowing for assessment in a more diverse subset of gender minorities.
We introduce two concepts—social certainty and social doubt—that help to articulate a variety of experiences of the social world, such as shyness, self-consciousness, culture shock, and anxiety. Following Carel's (2013) analysis of bodily doubt, which explores how a person's tacit confidence in the workings of their body can be disrupted and undermined in illness, we consider how an individual's faith in themselves as a social agent, too, can be compromised or lost, thus altering their experience of what is afforded by the social environment. We highlight how a loss of bodily or social certainty can be shaped and sustained by the environments in which one finds oneself. As such, we show how certain individuals might be more vulnerable to experiences of bodily and social doubt than others.
The present experiment compared the fear-related behaviour of a mouse strain selected over 101 generations for high litter size with that of a randomly selected strain. The H-strain, selected for large litter size, has a mean (± SD) litter size at birth of 21.5 ± 3.5 pups. The randomly bred C-strain has a mean (± SD) litter size of 9.6 ± 2.2 pups. The elevated plus-maze, the light:dark test and a resident:intruder test were used to measure how the mice responded to novelty. In the elevated plus-maze, a well-validated model of animal anxiety, the H-strain was significantly more anxious (having a lower percentage of entries into open arms) than the C-strain at 9 weeks of age. In the light: dark test, in which the light levels were similar to those in the home environment, the H-strain did not differ significantly from the C-strain in its avoidance of the brightest area. In the resident: intruder test, where aggression-trained, older H-strain males were the residents, 11-week-old intruding mice of the C-strain spent a higher percentage of their time in flight and immobility than intruders of the H-strain. There were clear anxiety- and fear-related differences between the strains, which may be related to their selection history. The results illustrate a need for further studies on the consequences of selection for increased production for the ability of animals to adapt to their home environment and cope with environmental changes.
Mental health issues increased during the COVID-19 pandemic, especially among children. Our past research efforts found that surveillance data can address a variety of health concerns; that personal psychological awareness impacted ability to cope, and mental health outcomes were improved when survivors were triaged to mental health countermeasures. To build upon our public health efforts we wanted to see if increased screen time due to remote learning caused by the pandemic influenced school aged children’s mental health.
With the hypothesis that excessive time spent isolated during remote learning increased the amount of mental health events in children, we conducted a public health surveillance project on actual diagnoses rather than just symptoms, controlling for historical mental health and emotional disorders.
The entire cohort of children ages 6 to 17 years were studied over time before and during the pandemic for their medically diagnosed mental health and emotional outcomes by the amount of pandemic induced social isolation.
After controlling for historical diagnoses and the rate of COVID-19, the effect of pandemic induced social isolation had a linear increase on the amount of anxiety, resulting in a four-fold increase in pandemic social isolation-induced anxiety.
In the past 10 years an increasing number of randomised trials have examined the effects of transdiagnostic treatments of patients with depression or anxiety. We conducted the first comprehensive meta-analysis of the outcomes of this emerging field.
We used the searches in PubMed, PsychINFO, Embase and the Cochrane library of an existing database of randomised trials of psychological interventions for depression to identify studies comparing a transdiagnostic treatment of patients with depression or anxiety with a control group (deadline 1 January 2022). We conducted random-effects meta-analyses and examined the effects on depression and anxiety at the short and longer term.
We included 45 randomised controlled trials with 51 comparisons between a psychotherapy and a control group and 5530 participants. Thirty-five (78%) studies were conducted in the last 10 years. The overall effect size was g = 0.54 (95% CI 0.40–0.69; NNT = 5.87), with high heterogeneity (I2 = 78; 95% CI 71–83), and a broad PI (−0.31–1.39). The effects remained significant in a series of sensitivity analyses, including exclusion of outliers, adjustment for publication bias, for studies with low risk of bias, and in multilevel analyses. The results were comparable for depression and anxiety separately. At 6 months after randomisation the main effects were still significant, but not at 12 months, although the number of studies was small.
Transdiagnostic treatments of patients with depression or anxiety are increasingly examined and are probably effective at the short term.
Climate change may affect mental health. We conducted an umbrella review of meta-analyses examining the association between mental health and climate events related to climate change, pollution and green spaces. We searched major bibliographic databases and included meta-analyses with at least five primary studies. Results were summarized narratively. We included 24 meta-analyses on mental health and climate events (n = 13), pollution (n = 11), and green spaces (n = 2) (two meta-analyses provided data on two categories). The quality was suboptimal. According to AMSTAR-2, the overall confidence in the results was high for none of the studies, for three it was moderate, and for the other studies the confidence was low to critically low. The meta-analyses on climate events suggested an increased prevalence of symptoms of post-traumatic stress, depression, and anxiety associated with the exposure to various types of climate events, although the effect sizes differed considerably across study and not all were significant. The meta-analyses on pollution suggested that there may be a small but significant association between PM2.5, PM10, NO2, SO2, CO and mental health, especially depression and suicide, as well as autism spectrum disorders after exposure during pregnancy, but the resulting effect sizes varied considerably. Serious methodological flaws make it difficult to draw credible conclusions. We found reasonable evidence for an association between climate events and mental health and some evidence for an association between pollution and mental disorders. More high-quality research is needed to verify these associations.
Environmental light-dark cycles play an important role in behavioural and physiological processes. It is essential that laboratory vivaria be designed to properly control the light conditions in which laboratory mice are housed; however, this is not universally the case. Some laboratory vivarium doors are designed with windows, which allow light from the hallways to leak into the housing space during the rodents’ dark phase. Personnel entering and exiting the housing space during the dark phase can also create excessive light leak from brightly illuminated hallways. In this study, we investigated the hypothesis that exposure to dim light at night, as commonly experienced in many laboratory rodent housing spaces, alters mouse (Mus musculus) behaviour. We specifically analysed patterns of locomotor activity, anxiety- and depressive-like responses. Exposure to dim (5 lux) light at night altered home-cage locomotor activity and increased anxiety and some depressive responses among laboratory mice. These results suggest that light conditions can alter mouse behaviour and potentially influence experimental outcomes. Increased care should be taken to properly control light-dark conditions for laboratory animals.
Both maternal and, separately, paternal mental illness are associated with diminished academic attainment among children. However, the differential impacts of diagnostic type and degree of parental burden (e.g. one v. both parents affected) on these functional outcomes are unknown.
Using the Swedish national patient (NPR) and multi-generation (MGR) registers, 2 226 451 children (1 290 157 parental pairs), born 1 January 1973–31 December 1997, were followed through 31 December 2013. Diagnostic status of all cohort members was defined for eleven psychiatric disorders, and families classed by exposure: (1) parents affected with any disorder, (2) parents affected with a disorder group (e.g. neuropsychiatric disorders), and (3) parents affected with a specific disorder (e.g. ADHD). Pairs were further defined as ‘unaffected,’ ‘single-affected,’, or ‘dual-affected.’ Among offspring, the study evaluated fulfillment of four academic milestones, from compulsory (primary) school through University (college). Sensitivity analyses considered the impact of child's own mental health, as well as parental education, on main effects.
Marked reductions in the odds of achievement were observed, emerging at the earliest levels of schooling for both single-affected [adjusted odds ratio (aOR), 0.50; 95% CI 0.49–0.51] and dual-affected (aOR 0.29, 95% CI 0.28–0.30) pairs and persisting thereafter [aOR range (single), 0.52–0.65; aOR range (dual), 0.30–0.40]. This pattern was repeated for analyses within diagnosis/diagnostic group. Main results were robust to adjustment for offspring mental health and parent education level.
Parental mental illness is associated with profound reductions in educational attainment in the subsequent generation, with children from dual-affected families at uniquely high risk.
During his last days at Oxford in 1840, John Ruskin inscribed in a new notebook, ‘I have determined to keep one part of diary for intellect and another for feeling.’ There is no diary for 1845, when Ruskin made his first Italian tour without his parents. Instead, broadly speaking, what Paul Tucker calls Ruskin’s Résumé is for intellect and the letters home to his father for feeling. The emphasis in this chapter is not upon the letters as travel writing or as indices of Ruskin’s intellectual journal, but rather upon their intrinsic qualities as communications between a son and his father that, though written abroad and taking nine or ten days to arrive, sustain the intimacy of a connection between two difficult and complex personalities who have a ‘strong desire to be speaking’ to one another. Whereas Browning and Barrett are embarking upon a new relationship, John Ruskin seeks to maintain an established connection with a beloved father whose demands are testing.
Mindful eating (ME) has been linked to improvement in binge eating disorder, but this approach in obesity management has shown conflicting results. Our aim was to assess the effect of ME associated with moderate energy restriction (MER) on weight loss in women with obesity. Metabolic parameters, dietary assessment, eating behaviour, depression, anxiety and stress were also evaluated. A total of 138 women with obesity were randomly assigned to three intervention groups: ME associated with MER (ME + MER), MER and ME, and they were followed up monthly for 6 months. ME + MER joined seven monthly mindfulness-based intervention group sessions each lasting 90 min and received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d). MER received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d), and ME joined seven monthly mindfulness-based intervention group sessions each lasting 90 min. Seventy patients completed the intervention. Weight loss was significant, but no statistically significant difference was found between the groups. There was a greater reduction in uncontrolled eating in the ME group than in the MER group and a greater reduction in emotional eating in the ME group than in both the MER and the ME + MER groups. No statistically significant differences were found in the other variables evaluated between groups. The association between ME with energy restriction did not promote greater weight loss than ME or MER.
Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings.
Key learning aims
(1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions.
(2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties.
(3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care.
Non-specific chest pain is one of the leading causes of admissions in paediatric cardiology outpatient clinics, and its management usually consists of extensive reassurance of patients and their families. As we have often observed that successful completion of treadmill testing during diagnostic work-up provides relief and reassurance in these patients and their families, we planned this study to quantitatively assess anxiety levels and perception of illness among children with non-specific chest pain before and after treadmill testing.
We studied 50 children (aged 11.8 ± 3.0 years, range 7–17 years; 24 females, 26 males) with a chief complaint of non-specific chest pain and negative history and echocardiography. They were asked to fill the Revised Children’s Anxiety and Depression Scale before the treadmill testing and 1–10 days after successful completion of treadmill testing.
Average total anxiety scores (36.38 ± 19.09 versus 33.36 ± 19.09, respectively) and average of total anxiety + depression scores (44.3 ± 24.92 versus 40.8 ± 26.97, respectively) of the children were found to be significantly lower after negative treadmill testing as compared to scores before testing (p < 0.05). Alterations in separation anxiety, panic, social phobia, obsession-compulsion scores were not statistically significant (p > 0.05).
Children with non-specific chest pain feel relieved and reassured after successful completion of treadmill testing. To the best of our knowledge, our study is the first in the literature to show this relationship quantitatively.
Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery.
We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children.
We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access.
There is a growing global awareness of the psychological consequences of long COVID, supported by emerging empirical evidence. However, the emergence and long-term trajectories of psychological symptoms following the infection are still unclear.
To examine when psychological symptoms first emerge following infection with SARS-CoV-2 and the long-term trajectories of psychological symptoms comparing long- and short-COVID groups.
We analysed longitudinal data from the UCL COVID-19 Social Study (March 2020 to November 2021). We included data from adults living in England who reported contracting SARS-CoV-2 by November 2021 (n = 3115). Of these, 15.9% reported having had long COVID (n = 495). They were matched to participants who had short COVID using propensity score matching on a variety of demographic, socioeconomic and health covariates (n = 962 individuals with 13 325 observations) and data were further analysed using growth curve modelling.
Depressive and anxiety symptoms increased immediately following the onset of infection in both long- and short-COVID groups. But the long-COVID group had substantially greater initial increases in depressive symptoms and heightened levels over 22 months follow-up. Initial increases in anxiety were not significantly different between groups, but only the short-COVID group experienced an improvement in anxiety over follow-up, leading to widening differences between groups.
The findings support work on the psychobiological pathways involved in the development of psychological symptoms relating to long COVID. The results highlight the need for monitoring of mental health and provision of adequate support to be interwoven with diagnosis and treatment of the physical consequences of long COVID.
This study aimed to (1) evaluate the prevalence and predictors of perceived depression, anxiety, stress (DAS) levels and emotional eating behaviours and (2) determine the correlations between DAS levels and emotional eating behaviours during the pandemic.
An online cross-sectional study included questions about demographic and anthropometric characteristics, dietary habits, Emotional Appetite Questionnaire (EMAQ) and Depression Anxiety Stress Scales. The snowball sampling method was used.
The study population was 2002 adults aged ≥18 years.
The mean age was 27·1 ± 9·52 years (72·1 % females and 27·9 % males). The prevalence of moderate to severe DAS was reported as 27·8 %, 30·5 % and 30·7 %, respectively. Skipping meals (OR = 1·32, 95 % CI (1·14, 1·49)) was associated with depression. Weight gain (OR = 1·43, 95 % CI (1·19, 1·66); OR = 1·30, 95 % CI (1·14, 1·49); OR = 1·39, 95 % CI (1·14, 1·64)), weight loss (OR = 1·45, 95 % CI (1·20, 1·70); OR = 1·37, 95 % CI (1·11, 1·62); OR = 1·46, 95 % CI (1·20, 1·72)), exercising at least 150 min/week (OR = 0·64, 95 % CI (0·46, 0·83); OR = 0·73, 95 % CI (0·55, 0·92); OR = 0·83, 95 % CI (0·63, 1·02)), and maintaining an adequate and balanced diet (OR = 0·52, 95 % CI (0·33, 0·71); OR = 0·53, 95 % CI (0·34, 0·73); OR = 0·63, 95 % CI (-0·15, 0·35)) were associated with DAS, respectively. BMI (r = 0·169, P < 0·001), weight (r = 0·152, P < 0·001), number of snacks (r = 0·102, P = 0·011), depression (r = 0·060, P = 0·007), anxiety (r = 0·061, P = 0·006) and stress (r = 0·073, P = 0·001) levels were positively correlated with EMAQ-negative scores.
Approximately one out of every three participants reported moderate to severe DAS levels. Emotional eating was significantly correlated with perceived DAS. The predictors obtained in the study suggest that a healthy diet and lifestyle behaviours are part of psychological well-being and emotional eating.
Employment and income are important determinants of mental health (MH), but the extent that unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.
We included adults 25–64 years from nine waves of the UK Household Longitudinal Study (n = 45 497/obs = 202 297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using double-robust marginal structural modelling, estimating odds ratios (OR) and absolute differences for effects of unemployment on CMD in the same year, before (TE) and after (CDE) blocking the income pathway. We calculated percentage mediation by income, with bootstrapped standard errors.
The TE of unemployment on CMD risk was OR 1.66 (95% CI 1.57–1.76), with 7.09% (6.21–7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46–1.66) and 6.08% (5.13–7.03). Income mediated 14.22% (8.04–20.40) of the TE. Percentage mediation was higher for job losses [15.10% (6.81–23.39)] than gains [8.77% (0.36–17.19)]; it was lowest for those 25–40 years [7.99% (−2.57 to 18.51)] and in poverty [2.63% (−2.22 to 7.49)].
A high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for younger people and those in poverty. Population attributable fractions suggested 16.49% of CMD burden was due to unemployment, with 13.90% directly attributable to job loss rather than resultant income changes. Similar analytical approaches could explore how this differs across contexts, by other factors, and consider longer-term effects.