Ezra Kipngetich Too, Peninah Wachira, Solomon Njenga
et al.
Background
Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.
Aims
The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.
Method
We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception to 15 February 2024. The keywords used in the search were ‘depression/anxiety/PTSD’, ‘healthcare workers’, ‘SSA’ and their variations.
Results
Sixty-nine studies met our inclusion criteria, most of which (n = 55, 79.7%) focused on the burden of these disorders during the COVID-19 pandemic. Across studies, wide-ranging prevalence estimates of depressive (2.1–75.7%), anxiety (4.8–96.5%) and PTSD symptoms (11.7–78.3%) were reported. These disorders appear to have been heightened during the COVID-19 pandemic. Several sociodemographic, health-related, COVID-19-related and work-related factors were reported to either increase or lower the risk of these disorders among HCWs from SSA.
Conclusions
The burden of depression, anxiety and PTSD among HCWs from SSA is high and appears to have been worsened by the COVID-19 pandemic. The correlates of these disorders among HCWs from this region are multifactorial. A multi-component intervention could contribute to addressing the burden of mental disorders among HCWs from this region.
Background With rapid population ageing, depressive symptoms in older adults have become a pressing public health concern. While functional dependency is a known risk factor, the impact of changes in dependency over time remains unclear.Objective To examine the association between changes in daily living dependency and incident depressive symptoms in older adults across international cohorts.Methods We used data from 46 327 adults aged ≥50 years across four longitudinal ageing studies: China Health and Retirement Longitudinal Study (China), Health and Retirement Study (USA), English Longitudinal Study of Ageing (England) and Survey of Health, Ageing and Retirement in Europe (Europe). Daily living dependency was classified into three levels based on difficulties in activities of daily living (ADLs) and instrumental ADLs (IADLs). Change in dependency was assessed using baseline and 2-year follow-up data. Depressive symptoms were measured using the Center for Epidemiologic Studies depressive symptoms Scale or the European Depression Scales (EURO-D). Cox proportional hazard models estimated HRs and 95% CIs for incident depressive symptoms over a median follow-up of 4.2–5.1 years.Findings A total of 12 902 new depressive symptom cases occurred during follow-up. Compared with participants whose dependency status remained unchanged, those who recovered to independency had a significantly reduced risk of depressive symptoms. Functional deterioration, including transitions from independency to ADL or IADL dependency, was associated with increased risk of depressive symptoms (both pooled HRs 1.55), while functional improvement, from ADL or IADL dependency to independency, was linked to reduced risk (HRs 0.83 and 0.80, respectively).Conclusions Improvement in ADL dependency is linked to a lower risk of depressive symptoms, while worsening dependency significantly increases depressive symptoms risk.Clinical implications Routine assessment of functional status and early interventions to maintain or restore daily living independency may help prevent depressive symptoms in older adults. Targeted rehabilitation and support services could play a key role in reducing the mental health burden of ageing populations.
Paula Saffie-Awad, Spencer M. Grant, Mary B. Makarious
et al.
Abstract Risk prediction models play a crucial role in advancing healthcare by enabling early detection and supporting personalized medicine. Nonetheless, polygenic risk scores (PRS) for Parkinson’s disease (PD) have not been extensively studied across diverse populations, contributing to health disparities. In this study, we constructed 105 PRS using individual-level data from seven ancestries and compared two different models. Model 1 was based on the cumulative effect of 90 known European PD risk variants, weighted by summary statistics from four independent ancestries (European, East Asian, Latino/Admixed American, and African/Admixed). Model 2 leveraged multi-ancestry summary statistics using a p-value thresholding approach to improve prediction across diverse populations. Our findings provide a comprehensive assessment of PRS performance across ancestries and highlight the limitations of a “one-size-fits-all” approach to genetic risk prediction. We observed variability in predictive performance between models, underscoring the need for larger sample sizes and ancestry-specific approaches to enhance accuracy. These results establish a foundation for future research aimed at improving generalizability in genetic risk prediction for PD.
Hael F. Abdulrazeq, Anna R. Kimata, Belinda Shao
et al.
Responsive neurostimulation (RNS) is a valuable tool in the diagnosis and treatment of medication refractory epilepsy (MRE) and provides clinicians with better insights into patients’ seizure patterns. In this case illustration, we present a patient with bilateral hippocampal RNS for presumed bilateral mesial temporal lobe epilepsy. The patient subsequently underwent a right sided LITT amygdalohippocampotomy based upon chronic RNS data revealing predominance of seizures from that side. Analyzing electrocorticography (ECOG) from the RNS system, we identified the frequency of high amplitude discharges recorded from the left hippocampal lead pre- and post- right LITT amygdalohippocampotomy. A reduction in contralateral interictal epileptiform activity was observed through RNS recordings over a two-year period, suggesting the potential dependency of the contralateral activity on the primary epileptogenic zone. These findings suggest that early targeted surgical resection or laser ablation by leveraging RNS data can potentially impede the progression of dependent epileptiform activity and may aid in preserving neurocognitive networks. RNS recordings are essential in shaping further management decisions for our patient with a presumed bitemporal epilepsy.
Neurology. Diseases of the nervous system, Neurophysiology and neuropsychology
BackgroundWith the onset of the COVID-19 pandemic, the world witnessed an unprecedented surge in the adoption of digital platforms across various sectors, including mental health care. In countries such as Pakistan, where traditional face-to-face therapy practices hold social and cultural significance, transitioning to digital therapeutic methods presents a range of unique opportunities and challenges.ObjectivesThis research aimed to explore the dynamics, implications, and perceptions surrounding digital therapeutic care within the Pakistani sociocultural context. Given the paucity of literature on this subject in the Pakistani context, this study aims to bridge the evidence gap between trends in digital therapy and localized practices. The main goal was to understand the benefits, issues, and challenges therapists and clients face when adopting digital modes for therapeutic care.MethodFor this study, primary data was gathered from counsellors and therapists using a qualitative in-depth interview guide. Using a thematic analysis approach, key themes were derived from the interviews that provided insights into the experiences and perceptions of the participants.ResultsThe study revealed that digital platforms have great potential in breaking down geographical barriers making therapeutic interventions more accessible to a wider demographic. This increased accessibility also brought about a level of comfort for clients as they could access therapy from their familiar surroundings. Among the challenges that needed attention, security and confidentiality stood out, requiring strict measures to safeguard client’s data. The shift also brought to light the diverse range of feedback from clients, which was influenced by factors like age and technological proficiency. Moreover, the digital transition posed challenges for both therapists and clients, with many facing an adjustment period as they transitioned from face-to-face to online sessions. One significant challenge was the perceived difficulty in fostering a deep interpersonal connection in a virtual environment. This was further compounded by the need for therapists to modify traditional therapeutic techniques to fit the online mode.Conclusion and implicationsThe study underscores the evolving nature of digital therapy in Pakistan, setting a foundation for further exploration in aligning technology with therapeutic needs, ensuring optimal benefits for clients while preserving the sanctity and efficacy of the therapeutic relationship.
Timothy J. Rich, Timothy J. Rich, Aubree Alexander
et al.
IntroductionIndividuals with multiple sclerosis (MS) frequently experience visual and oculomotor symptoms that may impact and confound neuropsychological assessments of information processing speed (IPS). In this study, we examined the effect of the psychostimulant methylphenidate on oculomotor function and the association between change in oculomotor speed and change in information processing speed.MethodsWe used a repeated measures crossover design in which a sample of 11 participants with MS were randomly assigned to one of two treatment arms: one that received methylphenidate for 4 weeks and another that received a placebo for 4 weeks. After a 7-day washout period, the treatments were crossed over. The King Devick test, the Symbol Digit Modalities Test, and the Paced Auditory Serial Addition Test were administered at baseline and after each of the two study arms.ResultsWe found a significant improvement in oculomotor speed in the methylphenidate condition as compared to placebo. This improvement was significantly correlated with improvement on a visuomotor assessment of IPS (Symbol Digit Modalities Test), but no such association was found for an auditory-verbal assessment of IPS (Paced Auditory Serial Addition Test).DiscussionThese findings suggest that individuals with MS experience improved oculomotor speed while taking methylphenidate, which may, in turn, improve performance on assessments of IPS with visuomotor demands.
Introduction
Emotion dysregulation (ED) is transdiagnostic domain that plays a pivotal role in the emergence and persistence of numerous mental disorders. Examining the extent of ED within non-clinical populations may shed light on whether ED is indeed linked to symptoms as observed in clinical settings. This investigation constitutes a crucial milestone toward the development of preventive strategies.
Objectives
To investigate the correlations between ED, psychopathological symptoms, risky behaviors, and environmental factors in adolescent students.
Methods
A total of N=610 students (16 years; 72% females) completed self-report standardized questionnaires measuring depression, anxiety, impulsivity, childhood trauma, relations with classmates, and family functioning. Lifetime risky-behaviours were recorded using an ad-hoc checklist, and ED through Difficulties in Emotion Regulation Scale (DERS). The sample was then divided into subgroups based on percentiles of DERS Total scores: N=210 low ED, N=187 moderate, N=214 high.
Results
Participants exhibiting high ED displayed higher level of depression, anxiety and impulsivity (Table 1). There was an observable trend linking higher levels of ED with a greater proportion of youths reporting risky behaviors (Table 2). The high ED group reported an increased frequency of childhood traumatic experiences, less favorable relationships with family members and classmates (Table 3).
Table 1.
Clinical symptoms by level of ED in students (N=610)
low
moderate
high
Sig.
Patient Health Questionnaire
(depression)
5.33(±3.51)
8.94(±4.05)
14.57(±5.53)
<.001
Screen For Child Anxiety Related Emotional Disorders (anxiety)
59.27(±9.61)
68.61(±10.88)
79.39(±11.61)
<.001
Barratt Impulsiveness Scale-Brief
(impulsivity)
15.14(±3.52)
16.70(±3.81)
18.01(±4.17)
<.001
Table 2.
Risky behaviors by level of ED in students (N=610)
low
moderate
high
Sig.
Binge drinking
N=73 (29.6%)
N=78 (31.6%)
N=96 (38.9%)
.097
Self-harm ideation
N=35 (13.4%)
N=73 (28%)
N=153 (58.6%)
<.001
Self-harm
N=30 (15%)
N=49 (24.5%)
N=121 (60.5%)
<.001
Binge eating
N=60 (22.9%)
N=78 (29.8%)
N=124 (47.3%)
<.001
Table 3.
Environmental factors by level of ED in students (N=610)
low
moderate
high
Sig.
Childhood Trauma Questionnaire (trauma)
30.99(±6.89)
35.39(±9.1)
39.54(±10.94)
<.001
Child And Adolescent Social Support Scale (classmate)
51.19(±11.7)
46.55(±10.96)
44.91(±12.4)
<.001
Family Assessment Device (family functioning)
117.58(±14)
108.8(±17.48)
103.38(±20.11)
<.001
Conclusions
Findings provide robust support for the association between ED and compromised personal functioning, even within a non-clinical sample. The trend observed in the relationship between ED, clinical symptoms and risky behaviors is consistent across all variables. Overall, these results contribute to the growing body of evidence advocating for preventive interventions aimed at addressing ED in adolescents.
Disclosure of Interest
None Declared
Taras O. Simaniv, Anna A. Belkina, Maria N. Zakharova
Demyelinating diseases of the central nervous system and multiple sclerosis in particular are a pressing issue for medical community and society as a whole. Deve- lopment and implementation of highly effective specific therapy significantly slow the disease progression and help maintain patients' quality of life and social participation. We analyzed pathogenic mechanisms of multiple sclerosis and other B cell-mediated diseases and reviewed therapeutic options for main disease stages.
Multiple single nucleotide polymorphisms may contribute to cognitive decline in Parkinson’s disease. However, the mechanism by which these single nucleotide polymorphisms modify brain imaging phenotype remains unclear. The aim of this study was to investigate the potential effects of multiple single nucleotide polymorphisms on brain imaging phenotype in Parkinson’s disease. Forty-eight Parkinson’s disease patients and 39 matched healthy controls underwent genotyping and 7T magnetic resonance imaging. A cognitive-weighted polygenic risk score model was designed, in which the effect sizes were determined individually for 36 single nucleotide polymorphisms. The correlations between polygenic risk score, neuroimaging features, and clinical data were analyzed. Furthermore, individual single nucleotide polymorphism analysis was performed to explore the main effects of genotypes and their interactive effects with Parkinson’s disease diagnosis. We found that, in Parkinson’s disease, the polygenic risk score was correlated with the neural activity of the hippocampus, parahippocampus, and fusiform gyrus, and with hippocampal-prefrontal and fusiform-temporal connectivity, as well as with gray matter alterations in the orbitofrontal cortex. In addition, we found that single nucleotide polymorphisms in α-synuclein (SNCA) were associated with white matter microstructural changes in the superior corona radiata, corpus callosum, and external capsule. A single nucleotide polymorphism in catechol-O-methyltransferase was associated with the neural activities of the lingual, fusiform, and occipital gyri, which are involved in visual cognitive dysfunction. Furthermore, DRD3 was associated with frontal and temporal lobe function and structure. In conclusion, imaging genetics is useful for providing a better understanding of the genetic pathways involved in the pathophysiologic processes underlying Parkinson’s disease. This study provides evidence of an association between genetic factors, cognitive functions, and multi-modality neuroimaging biomarkers in Parkinson’s disease.
Giulia Mazzari, Christopher A. Lowry, Dominik Langgartner
et al.
Chronic psychosocial stress is a burden of modern society and poses a clear risk factor for a plethora of somatic and affective disorders, of which most are associated with an activated immune status and chronic low-grade inflammation. Preclinical and clinical studies further suggest that a failure in immunoregulation promotes an over-reaction of the inflammatory stress response and, thus, predisposes an individual to the development of stress-related disorders. Therefore, all genetic (i.e., sex) and environmental (i.e., early life adversity; ELA) factors facilitating an adult's inflammatory stress response are likely to increase their stress vulnerability.In the present study we investigated whether repeated subcutaneous (s.c.) administrations with a heat-killed preparation of Mycobacterium vaccae (M. vaccae; National Collection of Type Cultures (NCTC) 11659), an abundant soil saprophyte with immunoregulatory properties, are protective against negative behavioral, immunological and physiological consequences of ELA alone or of ELA followed by chronic psychosocial stress during adulthood (CAS) in male and female mice. ELA was induced by the maternal separation (MS) paradigm, CAS was induced by 19 days of chronic subordinate colony housing (CSC) in males and by a 7-week exposure to the social instability paradigm (SIP) in females.Our data indicate that ELA effects in both sexes, although relatively mild, were to a great extent prevented by subsequent s.c. M. vaccae administrations. Moreover, although the use of different paradigms for males and females impedes a direct comparison, male mice seemed to be more susceptible to CAS than females, with only females benefitting slightly from the stress protective effects of s.c. M. vaccae administrations when given prior to CAS alone. Finally, our data support the hypothesis that female mice are more vulnerable to the additive effects of ELA and CAS than male mice and that s.c. M. vaccae administrations subsequent to ELA but prior to CAS are protective in both sexes.Taken together and considering the limitation that CAS in males and females was induced by different paradigms, our findings are consistent with the hypotheses that murine stress vulnerability during different phases of life is strongly sex dependent and that developing immunoregulatory approaches, such as repeated s.c. administrations with immunoregulatory microorganisms, have potential for prevention/treatment of stress-related disorders.
Neurosciences. Biological psychiatry. Neuropsychiatry, Neurology. Diseases of the nervous system
The K+-Cl− cotransporter KCC2 is responsible for maintaining low Cl− concentration in neurons of the central nervous system (CNS), which is essential for postsynaptic inhibition through GABAA and glycine receptors. Although no CNS disorders have been associated with KCC2 mutations, loss of activity of this transporter has emerged as a key mechanism underlying several neurological and psychiatric disorders, including epilepsy, motor spasticity, stress, anxiety, schizophrenia, morphine-induced hyperalgesia and chronic pain. Recent reports indicate that enhancing KCC2 activity may be the favored therapeutic strategy to restore inhibition and normal function in pathological conditions involving impaired Cl− transport. We designed an assay for high-throughput screening that led to the identification of KCC2 activators that reduce intracellular chloride concentration ([Cl−]i). Optimization of a first-in-class arylmethylidine family of compounds resulted in a KCC2-selective analog (CLP257) that lowers [Cl−]i. CLP257 restored impaired Cl− transport in neurons with diminished KCC2 activity. The compound rescued KCC2 plasma membrane expression, renormalized stimulus-evoked responses in spinal nociceptive pathways sensitized after nerve injury and alleviated hypersensitivity in a rat model of neuropathic pain. Oral efficacy for analgesia equivalent to that of pregabalin but without motor impairment was achievable with a CLP257 prodrug. These results validate KCC2 as a druggable target for CNS diseases.
The network theory of mental disorders conceptualizes psychiatric symptoms as networks of symptoms that causally interact with each other. Our present study aimed to explore the symptomatic structure in children with attention-deficit/hyperactivity disorder (ADHD) using network analyses. Symptom network based on 18 items of ADHD Rating Scale-IV was evaluated in 4,033 children and adolescents with ADHD. The importance of nodes was evaluated quantitatively by examining centrality indices, including Strength, Betweenness and Closeness, as well as Predictability and Expected Influence (EI). In addition, we compared the network structure across different subgroups, as characterized by ADHD subtypes, gender and age groups to evaluate its invariance. A three-factor-community structure was identified including inattentive, hyperactive and impulsive clusters. For the centrality indices, the nodes of “Distracted” and “Fidget” showed high closeness and betweenness, and represented a bridge linking the inattentive and hyperactive/impulsive domains. “Details” and “Fidget” were the most common endorsed symptoms in inattentive and hyperactive/impulsive domains respectively. On the contrary, the “Listen” item formed a peripheral node showing weak links with all other items within the inattentive cluster, and the “Loss” item as the least central node by all measures of centrality and with low predictability value. The network structure was relatively invariant across gender, age and ADHD subtypes/presentations. The 18 items of ADHD core symptoms appear not equivalent and interchangeable. “Distracted” and “Fidget” should be considered as central, or core, symptoms for further evaluation and intervention. The network-informed differentiation of these symptoms has the potentials to refine the phenotype and reduce heterogeneity.
Sally M. Gainsbury, Sally M. Gainsbury, Nicola Black
et al.
Internet gambling provides a unique environment with design mechanics and data-driven opportunities that can impact gambling-related harms. Some elements of Internet gambling including isolation, lack of interruption, and constant, easy access have been argued to pose specific risks. However, identifiable player accounts enable identification of behavioral risk markers and personalized private interfaces to push customized messages and interventions. The structural design of the Internet gambling environment (website or app) can have a strong influence on individual behavior. However, unlike land-based venues, Internet gambling has few specific policies outlining acceptable and unacceptable design practices. Harm minimization including responsible gambling frameworks typically include roles and responsibilities for multiple stakeholders including individual users, industry operators, government regulators, and community organizations. This paper presents a framework for how behavioral science principles can inform appropriate stakeholder actions to minimize Internet gambling-related harms. A customer journey through internet gambling demonstrates how a multidisciplinary nexus of collaborative effort may facilitate a reduction in harms associated with Internet gambling for consumers at all stages of risk. Collaborative efforts between stakeholders could result in the implementation of appropriate design strategies to assist individuals to make decisions and engage in healthy, sustainable behaviors.
Shemonti Hasan, Michelle M. Mielke, J. Eric Ahlskog
et al.
Objective. Autonomic symptoms are common in α-synuclein disorders: multiple system atrophy (MSA), Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and Parkinson’s disease with dementia (PDD). These symptoms may precede the motor findings/clinical diagnosis by years. Erectile dysfunction (ED) is an autonomic symptom that has rarely been studied in these α-synuclein disorders. In this population-based, case-control study, we investigated the association between premonitory erectile dysfunction surfacing prior to the clinical-motor manifestations of these α-synucleinopathies. Methods. We used the medical record-linkage system of the Rochester Epidemiology Project to identify cases of α-synucleinopathies in Olmsted County from 1991 to 2010. Each male case was matched by age (±1 year) of symptom onset and sex to a control. We reviewed complete medical records of cases and controls to detect erectile dysfunction prior to the clinical-motor onset of α-synucleinopathies of any type. We used conditional logistic regression to calculate the odds ratio of all α-synucleinopathies, as well as by type, adjusting for diabetes, coffee, and smoking. Results. A history of male erectile dysfunction was associated with 1.5-fold increased odds of an α-synucleinopathy diagnosis of any type in univariate analyses (p=0.06). When stratifying α-synucleinopathies by type, early erectile dysfunction was most frequent in MSA cases than matched controls (45% vs. 9%). Premotor phase ED was next most frequent among the DLB cases (46% vs. 27% among the controls; OR = 2.83, p=0.03; when adjusted for diabetes, smoking, and coffee, OR = 2.98, p=0.04). Premotor phase ED was not significantly associated with PD or PDD. Conclusions. Early erectile dysfunction may be a premotor symptom of MSA and DLB, reflecting premonitory dysautonomia. It was not associated with premotor PD or PDD.