Child and adolescent anxiety as a risk factor for bipolar disorder: A systematic review of longitudinal studies.

OBJECTIVES: Several studies have suggested that anxiety disorders in childhood and adolescence often precede the onset of bipolar disorder. We therefore systematically reviewed the relationship between child and adolescent anxiety and later bipolar disorder. METHODS: Online databases (Medline [for Ovid], EMBASE and PsychINFO) were searched for original, peer-reviewed studies examining the relationship between child and adolescent anxiety and later bipolar disorder. Studies in both community samples and bipolar offspring samples were included. RESULTS: A total of 16 studies were included in the review. The results were broadly consistent and revealed that child and adolescent anxiety disorders are associated with later bipolar disorder in community samples. In bipolar offspring, child and adolescent anxiety disorders are a marker of increased risk and predict the onset of bipolar disorder and other major mood disorders. CONCLUSIONS: There is evidence that anxiety disorders in childhood and adolescence increase the risk of later bipolar disorder. Anxiety disorders may be a useful target for early intervention in those at high-risk of bipolar disorder.

Innovations in Practice: Body dysmorphic disorder in youth - using the Development and Well-Being Assessment as a tool to improve detection in routine clinical practice.

BACKGROUND: Body Dysmorphic Disorder (BDD) is a distressing disorder that is widely underdetected in youth. This study aimed to examine the potential utility of the Development and Well-Being Assessment (DAWBA) as a tool to improve recognition of BDD in routine clinical practice. METHODS: One hundred and sixty-one patients assessed across two national and specialist child and adolescent mental health services, one specialising in mood disorders and one specialising in obsessive compulsive disorder and BDD, were included in this study. Results from the DAWBA were compared with clinical diagnosis to examine the utility of the DAWBA in detecting BDD. RESULTS: Only 27% of participants who received a diagnosis of BDD at assessment had been referred with concerns about appearance anxiety suggesting significant under detection in youth mental health services. Using the single-screener question on the DAWBA, it was possible to correctly identify 97% of cases with BDD. CONCLUSIONS: Body dysmorphic disorder often goes undetected in routine clinical practice. The DAWBA shows promise as a tool for helping clinicians to accurately detect BDD in routine clinical practice.

Impaired auditory selective attention ameliorated by cognitive training with graded exposure to noise in patients with traumatic brain injury.

Patients who suffer traumatic brain injury frequently report difficulty concentrating on tasks and completing routine activities in noisy and distracting environments. Such impairments can have long-term negative psychosocial consequences. A cognitive control function that may underlie this impairment is the capacity to select a goal-relevant signal for further processing while safeguarding it from irrelevant noise. A paradigmatic investigation of this problem was undertaken using a dichotic listening task (study 1) in which comprehension of a stream of speech to one ear was measured in the context of increasing interference from a second stream of irrelevant speech to the other ear. Controls showed an initial decline in performance in the presence of competing speech but thereafter showed adaptation to increasing audibility of irrelevant speech, even at the highest levels of noise. By contrast, patients showed linear decline in performance with increasing noise. Subsequently attempts were made to ameliorate this deficit (study 2) using a cognitive training procedure based on attention process training (APT) that included graded exposure to irrelevant noise over the course of training. Patients were assigned to adaptive and non-adaptive training schedules or to a no-training control group. Results showed that both types of training drove improvements in the dichotic listening and in naturalistic tasks of performance in noise. Improvements were also seen on measures of selective attention in the visual domain suggesting transfer of training. We also observed augmentation of event-related potentials (ERPs) linked to target processing (P3b) but no change in ERPs evoked by distractor stimuli (P3a) suggesting that training heightened tuning of target signals, as opposed to gating irrelevant noise. No changes in any of the above measures were observed in a no-training control group. Together these findings present an ecologically valid approach to measure selective attention difficulties after brain injury, and provide a means to ameliorate these deficits.

Factors associated with perceived health in older adult Irish population.

OBJECTIVES: Perceived health status or self-reported health declines with age and is associated with increased morbidity, mortality, poor mental health and functional outcomes and health care utilisation. The aim of this study was to investigate the relationship between a range of biopsychosocial measures and self-reported health in a sample of community-dwelling older people living in Dublin. METHOD: A total of 492 participants with a mean age of 72.5 (SD = 7.34) were assessed at the Technology Research for Independent Living (TRIL) clinic, a comprehensive geriatric assessment facility in St James's Hospital, Dublin, using standardised measures of medical morbidity, personality, functional status, depression, anxiety, perceived stress, cognition, loneliness and social support. The relationship between self-rated health and health measures was analysed using bivariate correlations and backward multiple regression. Indirect pathways of effects on perceived health were evaluated using bootstrapping mediation analysis. RESULTS: Self-rated health was best predicted by instrumental activities of daily living (IADL), Charlson Co-morbidity Index (CCI), extraversion and perceived stress. The effects of cognition and social support from friends on self-rated health were found to be mediated by elements of these identified factors. CONCLUSION: Self-rated health is not simply the absence of physical illness but is also strongly influenced by the degree of functional impairment, personality factors and the level of stress experienced by the older person.

Recruiting and retaining older persons within a home-based pilot study using movement sensors.

In this paper, we report on key aspects of recruiting and retaining a small group of community dwelling older adults in to a study, piloting motion sensors in their homes for 8 weeks. This was to further understanding of older adults' falls at home. We consider our recruitment strategy in terms of informed consent and non-exploitation; planning and explaining, and our retention strategy in terms of communicating and recording and pacing and sharing data. Offering reflective analyses of our challenges and strategies may help develop skills that maximise the involvement of older adults in research, particularly technologies related research, whilst at the same time ensuring inclusive and non-exploitative research relationships.