Psychiatry Int., Volume 1, Issue 2 (December 2020) – 9 articles

The purpose of this randomized, retrospective study was to investigate the possible association among levels of anxiety and depression and functional food consumption frequency, Mediterranean diet adoption and anthropometric indices in a sample of Greek, mainly young, adults. One hundred twenty healthy adults, 80% of whom were 18–35 years old, were randomly recruited from the North Aegean Islands, mainly from the Aegean University campus. The degree of anxiety was evaluated using the State-Trait Anxiety Inventory (STAI-X-1,2) whereas the degree of depression was assessed using the Beck Depression Inventory (BDI). Mediterranean diet adherence was evaluated using the Med Diet Score and functional foods consumption frequency by a validated food frequency questionnaire (FFQ). According to our results, the study did not show a statistically significant association between Mediterranean diet adherence and anxiety or depression levels (p > 0.05), and a trend association was observed only for the depression grouped score. In parallel, increased depression level was significantly correlated with an increased body mass index (BMI) (p = 0.019). In addition, the consumption of specific functional foods, such as beans, nuts, pomegranate, spinach and foods enriched with β-glucans, correlated with state-trait anxiety or depression levels, as well as with anthropometric indices (p < 0.05). The results of the study may contribute to the elucidation of the possible role of the Mediterranean diet and functional food consumption on self-esteem, anxiety and depression. Full article

Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not understand why some individuals have a greater magnitude of these biases, and why others have none. There has been little focus on elucidating individual differences and task parameters that affect the overall magnitude of the biases. In this opinion piece, we will attempt to identify these. We will then discuss both the research and clinical implications. Methods and Analysis: To identify the factors that modulated the magnitude of attentional biases across all the substance disorders (i.e., opioid use, cannabis use, and stimulant-use disorders), we performed a search using the bibliographic databases PubMed and MEDLINE. The search terminologies “attention bias” or “cognitive bias” or “approach bias” or “avoidance bias” were used when we looked for relevant articles. Results: It was evident from the published literature that several individual differences and factors modulated the magnitude of baseline biases. Across opioid, cannabis, and stimulant-use disorders, the most common individual differences identified were the severity of the dependence and the quantity of substance used. For both opioid and cannabis disorders the timing of stimulus presentation influenced the detection of attentional bias; it appeared that short stimulus timing was better able to detect attentional bias. Other identified individual differences included subjective craving and impulsiveness. The results highlight several research and clinical implications. Conclusions: The discovery of these individual differences and factors of the task paradigm that affect the magnitude of attentional biases will help in the future conceptualization of attention-bias-modification intervention. Full article

Determination of medical decision-making capacity (DMC) is one of the common encounters in Consultation-Liaison Psychiatry (CLP) services. It is a common misbelief that patients with “psych history” lack capacity more often than patients without mental illness. The study aims to examine the relationship between mental illness and DMC in patients presented to acute medical settings. The study is a retrospective chart review, where data were collected from the patients admitted to the medical units and assessed for capacity by a psychiatrist. Clinical and demographic characteristics were compared between two groups (patients having capacity and lacking capacity) using t-tests or chi-square tests, as appropriate. The commonest reason for DMC evaluation requests was for the patients who wanted to leave the hospital against medical advice. Overall, 53% (52/98) of the patients evaluated for DMC were found to lack capacity. Group of patients lacking DMC had a significantly higher percentage of males (58% vs. 35%) but were significantly less employed (8% vs. 10%). No significant difference was observed in other demographic characteristics and primary psychiatric diagnoses (past and current) among the two groups. However, patients lacking capacity were found to have a significantly more occurrence of current (48% vs. 11%) and past (23% vs. 4%) history of neurocognitive disorder, and larger trend significance (31% vs. 15%) of active psychiatric symptoms. We conclude that patients with neurocognitive disorders and active psychiatric symptoms might have poor DMC but not all patients who have psychiatric diagnoses lack medical DMC. Larger studies especially in outpatient psychiatric settings are suggested to derive more conclusive results. Full article

Background: Women taking advantage of medically assisted reproduction (MAR) techniques may differ from spontaneously conceiving women (nonMAR) in risk of depression and/or anxiety. We aimed to investigate possible differences between MAR and nonMAR through the use of the Edinburgh Postnatal Depression Scale in a sample of Italian-speaking women at their third trimester of pregnancy. Methods: We administered the Edinburgh Postnatal Depression Scale (EPDS) to two groups of pregnant women, MAR and nonMAR, at the third trimester of pregnancy (T0), one month after delivery (T1), and three months after delivery (T2) from February 2013 to December 2019. EPDS total scores cutoffs were ≥9 for risk of depression, 9–11 mild depression, ≥12 major depression, and the EPDS-3A cluster ≥4 was a proxy for anxiety. Results: Included were 1303 nonMAR women and 92 MAR, an expected disproportion. NonMAR and MAR women did not differ on depression or anxiety at any assessment timepoint. MAR women were older than nonMAR, consumed more alcohol and medical drugs, and displayed more complications during pregnancy. Scoring over the threshold on depression risk was associated with foreign nationality, unemployment, psychiatric history of the patient, family or partner, psychiatric problems in past pregnancies, hyperemesis, premenstrual syndrome (PMS), and stressful life events in the last year at baseline, and, for some of them, at other timepoints. In contrast, MAR past or current was associated with having suprathreshold depression at the first-month postpartum follow-up. Conclusions: Taken together, our data show that women opting for MAR do not differ from spontaneously conceiving women regarding psychiatric outcomes but do differ on some sociodemographic and clinical variables. Full article

Research has shown that non-pharmacological therapies can be useful in the treatment of Alzheimer’s disease (AD), significantly delaying cognitive decay. However, most AD interventions did not last beyond six months. Hence, little is known about the effect of these programs in the AD patients after six months of treatment. The purpose of this study was to evaluate the efficacy of the twelve-month Comprehensive Program of Cognitive Training (CPCT) for a sample of AD patients and to compare the results with the average annual rate of change. Thirty-nine AD patients participated in the study. The CPCT consists of a set of cognitive stimulations, intervention in activities of daily life (ADL), and motor training for 12 months. All patients were evaluated at baseline and in three-month intervals via the Mini Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), the Lawton Instrumental Activities of Daily Living Scale (IADL), and the Global Deterioration Scale (GDS). After CPCT implementation, there were no significant differences in the MMSE, IADL, and GDS evaluations between baseline and twelve months. Concerning the CAMCOG evaluation, there was no significant difference between the baseline and sixth-month assessments. Overall, the participants’ cognitive functioning did not decline when compared to the average annual rate of change. The CPCT extends the benefit of non-pharmacological interventions for AD patients to twelve months. Its implementation might provide the patients’ relatives with some guarantee concerning the delay of the disease. Future research may investigate the efficacy of the CPCT in comparison with a control group and over a more extended period. Full article

The advances in experimental psychology have led to the discovery of unconscious, automatic biases (attentional and approach biases) that account for the lapse and relapses amongst individuals with addictive disorders. To date, there has been extensive investigation into the assessment and modification of attention biases amongst individuals with the highly prevalent substance use disorders. Alternative modalities, such as technology, has also been evaluated for the delivery of these interventions. Given this, the specific objectives of this perspective article are in highlighting the emerging knowledge that has accrued over the last three years, and in addressing several of the research gaps in the previous article. Firstly, this perspective article will examine the evidence for biases and bias modification amongst the highly prevalent substance use disorders. This article will also examine how such bias modification has been utilized clinically. Secondly, this perspective article will also examine how technology has been applied to these bias modification interventions. Thirdly, this article will also examine the literature to highlight the biological underpinnings following bias modification. Fourthly, this article also examines the limitations of existing bias modification paradigms and methods taken to better these conventional interventions. The article concludes with highlighting the outstanding gaps in the current knowledge. To date, there remains mixed evidence for the modification of attention biases; and there are a paucity of studies examining the effectiveness of mobile delivery of bias intervention. Only one study has considered patients’ perspective in the development of an intervention. There remained several gaps in the knowledge, which future research could address. Full article

Cannabis and opioids are substances that affect reproductive health. Opioids suppress testosterone and studies have shown that cannabis may increase testosterone. However, there is minimal research describing the endocrine effects of concurrent cannabis and opioid use. We hypothesize that cannabis use improves opioid-induced testosterone suppression. To test this hypothesis, we used cross-sectional data from a prospective cohort study including 122 men enrolled in methadone maintenance treatment (MMT). We measured serum testosterone with an enzyme-linked immunosorbent assay at study enrolment. Urine drug screens were collected for 15 months and identified 52.5% of participants (n = 64) as cannabis users. The association between cannabis use and testosterone level was examined using regression models with serum testosterone as the dependent variable. In our multivariable regression, methadone dose was associated with lower serum testosterone (β = −0.003, 95% CI-0.005, −0.001, p = 0.003). However, neither cannabis use as a dichotomous variable nor the percentage of cannabis-positive urine drug screens were significantly associated with serum testosterone (β = 0.143, 95% CI −0.110, 0.396, p = 0.266, and β = 0.002, 95% CI > −0.001, 0.005, p = 0.116, respectively). Therefore, it does not appear that cannabis has an association with testosterone levels in men on MMT. Full article

Background: Sleep is critical to a person’s overall physical and mental health. The current study investigated the relationship between mindfulness and sleep quality, to determine if this relationship is influenced by emotion regulation and perceived stress. Method: Three hundred sixty-seven undergraduate students responded to five self-report measures, (1) The Cognitive and Affective Mindfulness Scale (CAMS-R), (2) The Impact of Event Scale (IES-R), (3) The Five Facet Mindfulness Questionnaire (FFMQ), (4) The Emotion Regulation Questionnaire (ERQ), and (5) The Pittsburgh Sleep Quality Index (PSQI). Results: Results revealed (1) sleep quality was predicted by the presence of hyperarousal, acting with awareness, and the CAMS-R, (2) the Impact of Event Scale was moderately positively correlated with a person’s global score on the Pittsburgh Sleep Quality Index, and (3) the relationship between mindfulness and sleep quality was mediated by hyperarousal. Conclusions: Together, our findings suggest that higher levels of intrusive thoughts, avoidance, and hyperarousal are correlated with lower overall sleep quality, and the use of mindfulness techniques such as acting with awareness and being non-reacting to negative thoughts or hyperarousal may help predict an individual’s sleep quality. Full article

Migraine is frequently comorbid with depression and anxiety disorders. In the case of depression and panic disorder, the associations seem to be bidirectional. Stress (activation of the hypothalamic-pituitary-adrenal axis) is thought to be involved in increasing the attack frequency. In the current review, it is argued that elevated levels of cortisol increase the function of chloride-ion transporter NKCC1 and decrease the function of chloride-extruder KCC2 in the trigeminal nerve. This leads to a diminished inhibitory effect of gamma-aminobutyric acid (GABA) and an enhanced likelihood of a migraine attack. Since migraine attacks themselves are stressful, and since brain areas are activated that could contribute to panic, anxiety and depression, a number of self-sustaining circular processes could occur that would explain the bi-directionality of the associations. On the basis of this hypothesis, several novel therapeutic approaches to counter the pathological process can be proposed. These include inhibition of corticotrophin releasing factor by CRF1 receptor antagonists, blockade of adrenocorticotropic hormone (ACTH) at the MC2 receptor, and inhibition of the hyperactive NKCC1 chloride-transporter. Full article