Wolferichter8125

ythm alteration. Although these disorders have their distinctive depressive and somatic features, they may from part of a wider group of Somatic Symptom Disorders (SSD), given the findings of the same pattern of cortisol secretion in both disorders and increased frequency of overlapping clinical features. V.BACKGROUND This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine whether HRV is different in patients with PD after treatment. METHODS Literature databases were searched for studies comparing resting-state HRV between drug-naïve patients with PD and healthy controls. Parameters from the short-term frequency-domain and long-term time domain were included. RESULTS In the low frequency (LF) analysis, no significant association was found between LF and PD (standardised mean difference [SMD] = -0.0443, 95% confidence interval [CI] -0.1765 to 0.0879). In the high frequency (HF) analysis, no significant association was found between HF and PD (SMD = -0.1269, 95% CI -0.2598 to 0.0059). In the LF/HF analysis, a significantly higher LF/HF ratio was found in cases than in controls, but the effect was moderate (SMD = 0.1390, 95% CI 0.0180 to 0.2600). For the standard deviation of normal-to-normal intervals, a significantly lower value was observed in cases than in controls (SMD = -0.3133, 95% CI -0.5459 to -0.0808). LIMITATIONS Limited sample size in the time-domain and treatment effect analyses. CONCLUSIONS Patients with PD had a higher short-term LF/HF ratio, indicating impaired sympathovagal balance. The LF/HF ratio findings were more consistent compared with LF and HF alone, making it a better parameter to interpret the LF and HF in conjunction. HRV may be a promising biomarker for predicting antidepressant response. V.BACKGROUND During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. OBJECTIVES This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. METHOD A nonclinical sample of 408 pregnant women (Mage = 28.24 years, SDage = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. FINDINGS Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. CONCLUSIONS The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women. BACKGROUND Comorbid alcohol use disorder (AUD) is common among patients with major depressive disorder (MDD), and often complicates presentation and treatment. However, there is a scarcity of clinical studies investigating the characteristics and outcome of psychiatric MDD patients with AUD. METHODS In the Vantaa Depression Study (VDS), a five-year prospective study of psychiatric out- and inpatients (N = 269) with MDD, we investigated the clinical features of MDD, comorbid Axis I and II disorders, psychosocial factors, and long-term outcome of patients with or without AUD. RESULTS Depressed patients with comorbid AUD at baseline (n = 66/269, 24.5%) were more often male (OR=3.57, [95% CI 1.72 - 7.41], p = 0.001), had more suicidal ideation (OR=1.06 [1.02 - 1.11], p = 0.008), comorbid panic disorders (OR=3.44 [1.47 - 8.06], p = 0.004), symptoms of any personality disorder (OR=1.04 [1.00 - 1.08], p = 0.038), and more often smoked daily (OR=2.79 [1.32 - 5.88], p = 0.007) than those without. At five years, 13.9% (25/180) still had AUD. More specifically, alcohol abuse was associated with suicide attempts, and dependence with suicidal ideation, and Cluster B personality disorder. Patients with AUD spent more time depressed and had more suicide attempts during follow-up. LIMITATIONS We did not investigate other substance use disorders. The AUD diagnoses were based on DSM-IV criteria. CONCLUSIONS Psychiatric MDD patients with comorbid alcohol use disorders have characteristics consistent with the epidemiology of AUDs in the general population. They are more often males and smoke, and have more comorbid mental disorders and suicidal behavior. Prospectively they spend more time depressed, thus having worse outcomes than patients without AUDs. BACKGROUND Many depressed patients are not able to achieve or sustain symptom remission despite serial treatment trials - often termed "treatment resistant depression". A broader, perhaps more empathic concept of "difficult-to-treat depression" (DTD) was considered. METHODS A consensus group discussed the definition, clinical recognition, assessment and management implications of the DTD heuristic. RESULTS The group proposed that DTD be defined as "depression that continues to cause significant burden despite usual treatment efforts". All depression management should include a thorough initial assessment. When DTD is recognized, a regular reassessment that employs a multi-dimensional framework to identify addressable barriers to successful treatment (including patient-, illness- and treatment-related factors) is advised, along with specific recommendations for addressing these factors. The emphasis of treatment, in the first instance, shifts from a goal of remission to optimal symptom control, daily psychosocial functional and quality of life, based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including pharmacotherapy, psychotherapy, neurostimulation, etc.) to optimize outcomes when sustained remission is elusive. LIMITATIONS The recommended definition and management of DTD is based largely on expert consensus. While DTD would seem to have clinical utility, its specificity and objectivity may be insufficient to define clinical populations for regulatory trial purposes, though DTD could define populations for service provision or phase 4 trials. CONCLUSIONS DTD provides a clinically useful conceptualization that implies a search for and remediation of specific patient-, illness- and treatment obstacles to optimizing outcomes of relevance to patients. V.OBJECTIVES Bipolar Disorder (BD) is frequently comorbid with other psychiatric disorders. click here However, few studies systematically examine which disorders are more likely to occur pre- or post-BD onset. We examine the prevalence and Age At Onset (AAO) of psychiatric conditions in adults with BD. METHODS A structured clinical interview was used to assess lifetime history and AAO of alcohol and cannabis misuse, suicide attempts, anxiety and eating disorders in a French sample of euthymic patients with BD (n = 739). Regression analyses were used to test for statistically significant associations between rates and AAO of comorbidities in BD groups stratified by sex or subtype. RESULTS Prevalence of alcohol and cannabis misuse was associated with male sex and BD-I subtype; whilst most anxiety and eating disorders were associated with female sex. The AAO of most comorbid conditions preceded that of BD, except for panic disorder, agoraphobia and alcohol misuse. Few variations were observed in AAO of comorbidities according to groups. LIMITATIONS All assessments were retrospective, so estimates of prevalence rates and especially exact AAO of some comorbidities are at risk of recall bias. CONCLUSIONS Sex and BD subtype are associated with different rates of comorbid disorders. However, there were minimal between group differences in median AAO of comorbidities. By describing the chronological sequence of comorbidities in BD we were able to demonstrate that a minority of comorbidities typically occurred post-onset of BD. This is noteworthy as these disorders might be amenable to interventions aimed at early secondary prevention. BACKGROUND About 1.4 million adults in North Carolina (NC) have mental illnesses. Many get no treatment because of mental health care provider shortages. Necessary prevention requires identification of covariates of mental illness. STUDY OBJECTIVE We tested the hypotheses There is no difference in adulthood mental health of the ACE-affected and the unaffected; ACEs do not significantly predict adulthood mental health. METHODS ACEs studied were living with a mentally ill person, an alcoholic, or drug abuser; witnessing violence; having divorced or unmarried parents; and being physically, mentally or sexually abused. We used data from 2012 and 2014 NC Behavioral Risk Factor Surveillance System. We had 19,187 observations with about 13,900 including ACE data. We conducted t- and χ2 tests of mental health differences between ACE-affected and unaffected and regression analysis to determine mental health predictors. RESULTS ACE distribution was 26.2% had parents or adults swearing at- or insulting them; 25% had divorced or unmarried parents; 22.6% lived with an alcoholic; 15.7% witnessed their parents beat each other; 13.8% lived with a mentally ill person; and 13.6% were hit or beaten by an adult in the home. Respondents also reported being touched sexually (9.4%); living with an adult who abused drugs (7.9%); and 4.1% were forced to have sex. The ACE-affected experienced significantly (p  less then  0.001) more days of poor mental health and had a higher likelihood of depression diagnosis than the unaffected. ACEs are statistically significant predictors of poor mental health in adulthood. V.BACKGROUND Patients with Borderline Personality Disorder (BPD) are characterized by impoverished self-regulatory mechanisms and self-image distortions. An intriguing question is to what extent BPD individuals develop accurate perceptions of their self-regulatory everyday functioning. Here, we tackle this issue evaluating their metacognitive abilities. METHODS One hundred and forty-four participants were enrolled in the study and divided into a BPD group and a healthy Control group, with each consisting of 36 participants paired with their corresponding close relatives. We compared self-report evaluations of the participants' self-regulatory processes in daily-life activities and personality traits with external perceptions by close relatives, as a measure of metacognition. The ratings from participants and their informants were compared using an ANCOVA profile analysis. RESULTS Self-report results showed poor self-regulation ability in the daily environment as well as extreme scores in personality-traits in the BPD group in comparison with healthy participants.