A comparative study of perceived burden in parent caregivers of adolescents with epilepsy in a resource-restricted setting: Investigating the explanatory factors of perceived burden.

OBJECTIVE: Parent caregivers often play vital roles in the care of adolescents with epilepsy (AWE) in resource-restricted settings; however, little is known about the burden borne by these parents. This study investigated the burden perceived by parents of AWE and described the explanatory factors. METHODS: An equal number (n = 121) of age- and gender-matched parent caregivers of AWE (cases) and parents of adolescents with sickle cell disease (comparison group) were interviewed with the Parent Illness Intrusiveness Rating Scale to assess disruptions in their relationships and lifestyle. Parents of AWE were assessed for psychological distress with the 12-item General Health Questionnaire, and AWE were interviewed with the Hospital Depression-Anxiety Scale. RESULTS: The majority of the cases and the comparison group were mothers (76%), with mean (SD) ages of 44.11 (SD = 6.92) versus 43.59 (SD = 6.39) years, respectively. The prevalence rate of psychological distress in cases was 38%, and depressive-anxiety symptom was prevalent in 39.7% of AWE. The level of perceived burden was significant in all parent caregivers, albeit higher in cases relative to the comparison group across multiple domains, including relationship/personal development, intimacy, instrumental and global. A high level of burden in parents of AWE was predicted by a poor family financial and material support to the adolescents, increased contact hours with adolescents, psychological distress in the parent caregivers, and anxiety-depressive symptoms in AWE after controlling for cofounders. CONCLUSION: The study findings underscore the need for psychosocial support to bolster resilience and adaptive coping styles in parents of AWE, particularly in resource-restricted settings. A culturally sensitive interdisciplinary blueprint of locally viable actions model for psychosocial support for parent caregivers of AWE is strongly suggested. Future studies are indicated to shed more light on the modifiable risks of perceived burden, and the effectiveness of psychosocial interventions in parents of AWE.

Psychological distress and sleep problems in healthcare workers in a developing context during COVID-19 pandemic: Implications for workplace wellbeing.

BACKGROUND: Emotional wellbeing of healthcare workers is critical to the quality of patient care, and effective function of health services. The corona virus disease-2019 (COVID-19) pandemic exerted unique physical and emotional demands on healthcare workers, however little is known about the emotional wellbeing of healthcare workers during the COVID-19 pandemic in resource-restricted settings. This study investigated the prevalence of psychological distress, and sleep problems in healthcare workers in a COVID-19 referral hospital in Nigeria. METHODS: A total of 303 healthcare workers were interviewed with the 12-item General Health Questionnaire (GHQ-12) to evaluate psychological distress, and the Pittsburgh Sleep Quality Index (PSQI) to assess multidimensional aspects of sleep, including quality, latency, duration, habitual efficiency, disturbances, use of sleeping medications and daytime dysfunction. RESULTS: The participants were mostly males, 183(60.4%) and mean age was 38.8(SD = 8.9) years. Most of the participants were married (70.3%), had spent less than 10 years in service (72.9%), and had no medical comorbidity (92.1%). The prevalence of psychological distress was 23.4%, and six in every ten participants reported sleep problems. The largest proportion of participants reported difficulty in sleep latency (81.5%), duration (71.3%), and daytime dysfunction (69.6%), while approximately one third (32%) each reported using sleep medication, and had difficulty with sleep quality. Psychological distress was inter-related with poor sleep problems (p = 0.001; effect size = 0.2). CONCLUSION: The prevalence rates of psychological distress and sleep problems during the COVID-19 pandemic were several folds the rates previously reported in similar contexts. Preventative psychosocial support services for healthcare workers are indicated. The creation of a culturally-sensitive interdisciplinary blueprint for locally-viable actions model are strongly suggested ahead of future emergency situations.

The impact of a psychosocial program on clinical outcomes for severe psychiatric disorders.

BACKGROUND: This retrospective study evaluated the impact of a psychosocial program on individuals with severe and chronic psychiatric disorders. This study also examined potential modifiable predictors of hospitalization. METHODS: The sample was comprised of 94 individuals with severe and chronic mental illness who were followed in the Community Support Network (CSN), a psychosocial program. Data from initial assessment at admission to the CSN were compared with the last assessment after admission, during data abstraction. Data were analyzed using analysis of variance for hospitalization, accommodation (housing), and employment, and the logistic regression procedure was used to analyze the relationship among potential modifiable clinical independent variables and hospitalization. RESULTS: Admission to CSN significantly reduced hospitalization rates. Presence of psychotic symptoms increased the likelihood of hospitalization, and the use of support groups, antidepressants, and mood stabilizers decreased the risk for hospitalization. CONCLUSIONS: Our findings suggest that CSN reduced hospitalization rates as well as increased employment, and the switch from the Assertive Community Treatment program to the Community Support Team program in 2007 did not change this effect. The overall significant reduction in psychiatric symptoms could explain these positive findings.

Acute Blood Pressure Changes Associated With Antipsychotic Administration to Psychiatric Inpatients.

OBJECTIVE: To investigate blood pressure (BP) changes within the first 3 days after initiating antipsychotic medication in psychiatric inpatients. METHODS: Through retrospective chart review using a repeated measures design, vital signs data were collected on 60 adult psychiatric inpatients who were psychiatrically hospitalized May 26, 2011, through September 4, 2012, at 9 time points within 3 days of initiation of 1 of 6 different antipsychotic medications. The random sample included patients with the following DSM-IV-TR diagnoses: schizophrenia (n = 25), schizoaffective disorder (either type; n = 19), and bipolar I disorder (n = 16). Data were analyzed using mixed-effects repeated measures analysis of variance to evaluate associations between the antipsychotic initiated and subsequent changes in BP. The main outcome variable was change in BP from baseline, and independent variables included age, sex, psychiatric diagnosis, and type of antipsychotic medication. Logistic regression was used to assess the relationship between each type of antipsychotic and hypotension (BP < 90/60 mm Hg) and hypertension (BP ≥ 140/90 mm Hg). RESULTS: Olanzapine (P < .01) and risperidone (P = .01) raised systolic BP to a statistically significant degree during the first 3 days after initiation. Clozapine, on the other hand, significantly reduced systolic BP (P = .02) and was associated with hypotension on linear regression. No statistically significant associations were found between the other antipsychotics and acute systolic BP changes or between any of the 6 antipsychotics and diastolic BP changes. CONCLUSIONS: Initiation of certain antipsychotic medications may be associated with statistically significant acute BP changes. These findings require further evaluation in well-designed prospective studies.

Longitudinal assessment of clinical risk factors for depression in schizophrenia spectrum disorders.

BACKGROUND: During initial assessment of individuals with schizophrenia and related disorders (schizophrenia spectrum disorders [SSDs]), clinicians tend to pay greater attention to psychotic symptoms than mood symptoms, including depression. Depression is reported to influence the course of SSDs, but not much is known about the risk factors for depression in SSDs. In the present study, we examined clinical predictors of depression in SSDs. METHODS: The sample included 71 patients with SSDs followed in a modified Assertive Community Treatment program, the Community Support Network of Springfield, Illinois. The study design was naturalistic, prospective, and longitudinal (mean follow-up = 8.3 years; SD = 7.3). The GENMOD procedure appropriate for repeated measures analysis with dichotomous outcome variables followed longitudinally was computed. RESULTS: Rates of depression ranged from 18% to 41% over the differing assessment periods. Schizophrenia and schizoaffective disorder did not vary by depression rate. Depression independent of SSD diagnosis was associated with greater hospitalization rates. Clinical variables predict- ing depression were auditory hallucinations, delusions, poor insight, and poor judgment. CONCLUSIONS: Psychotic symptoms in the course of SSDs are risk factors for depression. As a consequence, the mental status examination of patients with SSDs with active psychosis should include assessment of mood changes. Further research is warranted to determine if treatment of depression among patients with SSDs may reduce their rates of hospitalization.

Transitive inference deficits in unaffected biological relatives of schizophrenia patients.

Currently available treatments have limited efficacy in remediating cognitive impairment in schizophrenia. Efforts to facilitate cognition-enhancing drug discovery recommend the use of varied experimental cognitive paradigms (including relational memory) as assessment tools in clinical drug trials. Although relational memory deficits are increasingly being recognized as a reliable cognitive marker of schizophrenia, relational memory performance among unaffected biological relatives remains unknown. Therefore, we evaluated 73 adolescents or young adults (22 first- and 26 second-degree relatives of schizophrenia patients and 25 healthy controls (HC)) using a well-validated transitive inference (TI) experimental paradigm previously used to demonstrate relational memory impairment in schizophrenia. We found that TI deficits were associated with schizophrenia risk with first-degree relatives showing greater impairment than second-degree relatives. First-degree relatives had poorer TI performance with significantly lower accuracy and longer response times than HC when responding to TI probe pairs. Second-degree relatives had significantly quicker response times than first-degree relatives and were more similar to HC in TI performance. We further explored the relationships between TI performance and neurocognitive domains implicated in schizophrenia. Among HC, response times were inversely correlated with FSIQ, verbal learning, processing speed, linguistic abilities and working memory. In contrast, relatives (first-degree in particular) had a differing pattern of TI-neurocognition relationships, which suggest that different brain circuits may be used when relatives encode and retrieve relational memory. Our finding that unaffected biological relatives of schizophrenia patients have TI deficits lends further support for the use of relational memory construct in future pro-cognition drug studies.

Social adaptive functioning, apathy, and nondysphoric depression among nursing home-dwelling very old adults.

BACKGROUND: Apathetic and subsyndromal depressive conditions are common in the oldest old. This study examined whether nondysphoric depression (NDD), a clinical condition characterized by ideational and vegetative but no emotional symptoms of depression, belongs to the apathetic presentations of late-life depression. Rates of NDD, dysphoric depression (DD), apathy, and social functional impairment were examined in a sample of nondemented very old (mean age 87.5 years, SD = 7.7) nursing home residents. It was hypothesized that individuals with NDD show greater apathy and greater social functional impairment relative to DD and nondepressed individuals. METHODS: Social functioning was measured using the Social-Adaptive Functioning Evaluation (SAFE) and apathy was measured using the global apathy rating on the Scale for the Assessment of Negative Symptoms (SANS). RESULTS: The rates of DD (50.0%) and NDD (27.4%) were quite high. Participants with DD reported greater apathy than those with NDD (and nondepressed individuals). NDD and DD subjects showed greater social functional impairment relative to the comparison group. There was no difference in social functioning between DD and NDD individuals. CONCLUSIONS: The present data are inconsistent with the view that NDD among the oldest old is an apathetic form of depression. NDD involves social functional impairment. Limitations include rather selected population of nursing home residents that may have included individuals with early dementia, lack of data on prior depressive episodes, and apathy assessment not validated on the specific population.

Modifiable risk factors for depressed mood among farmers.

BACKGROUND: Risk for depression among farmers is not fully understood. DSM-IV considers sadness or depressed mood a critical symptom of depression. The aim of this study was to examine risk factors for depressed mood among farmers using a longitudinal study design. METHODS: Participants were principal farm operators in the Iowa Certified Safe Farm study. We identified risk factors for depressed mood by calculating relative risks (RR) using the generalized estimating equations method. RESULTS: In the multivariate model, pesticide exposure (RR = 1.26; 95% CI: 1.04 to 1.53), having an additional job off the farm (RR = 1.32; 95% CI: 1.08 to 1.62), stress (RR = 3.09; 95% CI: 2.55 to 3.75), and previous injury (RR = 1.41; 95% CI: 1.05 to 1.89) prospectively increased the risk of depressed mood. CONCLUSIONS: Consistent with earlier non-longitudinal studies, the results of this study suggest that reducing pesticide exposure, stress, and injury may reduce the risk of depression in the farm setting.

Beyond alcoholism: Wernicke-Korsakoff syndrome in patients with psychiatric disorders.

OBJECTIVE: Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. METHODS: A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. RESULTS: Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. CONCLUSIONS: Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency.

An initial study of modifiable and non-modifiable factors for late-life psychosis.

OBJECTIVE: To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. METHOD: A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein's Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. RESULTS: There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). CONCLUSIONS: Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.