Genetics of bipolar disorder

Importance The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.

Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis

Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

Background. Several psychometric instruments are available for the diagnostic interview of subjects at ultra high risk (UHR) of psychosis. Their diagnostic comparability is unknown. Methods. All referrals to the OASIS (London) or CAMEO (Cambridgeshire) UHR services from May 13 to Dec 14 were interviewed for a UHR state using both the CAARMS 12/2006 and the SIPS 5.0. Percent overall agreement, kappa, the McNemar-Bowker χ (2) test, equipercentile methods, and residual analyses were used to investigate diagnostic outcomes and symptoms severity or frequency. A conversion algorithm (CONVERT) was validated in an independent UHR sample from the Seoul Youth Clinic (Seoul). Results. There was overall substantial CAARMS-versus-SIPS agreement in the identification of UHR subjects (n = 212, percent overall agreement = 86%; kappa = 0.781, 95% CI from 0.684 to 0.878; McNemar-Bowker test = 0.069), with the exception of the brief limited intermittent psychotic symptoms (BLIPS) subgroup. Equipercentile-linking table linked symptoms severity and frequency across the CAARMS and SIPS. The conversion algorithm was validated in 93 UHR subjects, showing excellent diagnostic accuracy (CAARMS to SIPS: ROC area 0.929; SIPS to CAARMS: ROC area 0.903). Conclusions. This study provides initial comparability data between CAARMS and SIPS and will inform ongoing multicentre studies and clinical guidelines for the UHR psychometric diagnostic interview.

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Towards a Standard Psychometric Diagnostic Interview for Subjects at Ultra High Risk of Psychosis: CAARMS versus SIPS

Aim:

The study aimed to examine whether the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) has good construct validity, concurrent validity and reliability.



Methods:

Validity was established on a sample of 58 Tunisian adolescents and young adults aged between 16 and 30 years. These subjects were divided into three groups according to the CAARMS scores: ultra-high risk positive subjects (UHR (+) ) (n = 22), ultra-high risk negative subjects (UHR (–) ) (n = 25) and subjects meeting the criteria of a first-episode psychosis (FEP) (n = 11). For construct validity, we used the convergent validity. We used the Positive and Negative Syndrome Scale (PANSS) concomitantly with the CAARMS. For concurrent validity, we studied the correlation between symptoms of the CAARMS and their equivalents in the PANSS. The CAARMS reliability was conducted by the study of interrater reliability.



Results:

The UHR (+) group was shown with intermediate scores of PANSS between the two groups UHR (–) and FEP. That confirms a good construct validity of the Arabic version of the CAARMS. We noted a correlation between the scores in positive and negative sections measured by the CAARMS and their corresponding level of the PANSS. These results show that the CAARMS has a good concurrent validity with the PANSS. For the reliability study, we noted a good correlation between the two raters with a Pearson coefficient ranging from 0.55 to 0.90.



Conclusion:

Analysis of the results of construct validity, concurrent validity and reliability of the CAARMS indicates that this version translated into Arabic is valid and reliable.

Validation of the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) in Tunisian adolescents and young adults.

Reliability and validity of the Arizona sexual experiences scale-Arabic version in Tunisian patients with schizophrenia

In light of different challenges associated with the COVID-19 pandemic, university students are considered a particularly vulnerable population to mental health and study engagement issues. The first years at university represent a crucial period for students and are associated with an increase in mental health problems, particularly in healthcare studies. This study aimed (1) to document the current levels of mental health and study engagement among healthcare students in Tunisia, and (2) to investigate the relationships between emotional regulation, optimism, study engagement and common mental health problems (stress, anxiety and depression) among this population. A cross-sectional, electronic survey-based research design was used to draw a sample of 366 health care students from a University in Tunisia. Participants mostly reported mild (34.7%) or moderate (44.3%) levels of depression, moderate (44.7%) or severe (33.6%) levels of anxiety, average (50.8%) or mild (33.8%) levels of stress, and high levels of study engagement (>85%). Through structural equation modelling, the results showed that emotional regulation negatively affected stress, anxiety, and depression. Optimism partially mediated the relationship between emotional regulation, anxiety and depression and fully mediated the relationship between emotional regulation and study engagement. The findings indicated a high prevalence of psychological distress among healthcare university students in Tunisia, and specific protective factors that may be targeted to reduce mental health problems.

https://www.mdpi.com/1660-4601/19/3/1413/pdf

Mental Health during COVID-19 Pandemic: The Role of Optimism and Emotional Regulation

Objectives We aimed to assess sleep quality of Tunisian medical students during home confinement due to the COVID-19 pandemic, and to analyze the relationship between sleep quality and sociodemographic, clinical, confinement-related and psychological variables. Methods A correlational cross-sectional study was conducted from April 11th to May 3rd 2020. Medical students who have been in home confinement and who accepted to participate in an online survey were targeted. Sociodemographic data, clinical variables, and data related to home confinement were collected. Participants also completed Pittsburgh Sleep Quality Index, Depression, Anxiety and Stress Scale and Beck Hopelessness Scale. Results Results showed a high prevalence of poor sleepers among medical students (72.5%) with poor subjective sleep quality, increased sleep latency, sleep disturbances and daytime dysfunction. Multiple regression analysis revealed that family history of suicide attempts, tobacco use, perception of home confinement and reduced physical activity during home confinement significantly contributed to poor sleep quality. Among the psychological variables, anxiety and hopelessness significantly contributed to poor sleep quality in medical students during home confinement. Conclusions Results revealed a high prevalence of poor sleep quality in medical students who have been in home confinement due to the COVID-19 pandemic. Except family history of suicide attempts, factors that significantly contributed to poor sleep quality were modifiable factors. Sleep quality and sleep parameters need to be assessed in this particular population and adequate measures aiming to promote quality of sleep need to be enhanced, given the crucial regenerative, homeostatic and psychological roles of sleep.

Predictors of sleep quality in medical students during COVID-19 confinement.

INTRODUCTION: Chez le personnel soignant, le burnout touche un infirmier sur trois. Ce taux est plus eleve dans les unites prenant en charge des patients en fin de vie. L'objectif de notre travail etait d'evaluer la frequence du burnout chez les infirmiers qui travaillent en soins de fin de vie. METHODE: Il s'agit d'une etude descriptive transversale realisee entre le 1 er Avril et le 31 Mai 2010. 60 infirmiers de six services de Sousse et de Monastir (Tunisie) ont ete recrutes. L'evaluation du burnout a ete realisee par deux echelles : MBI (Maslach Burnout Inventory) et BMS (Burnout Measure Short version). RESULTAT: La prevalence du burnout etait de 70% ; il etait eleve chez 81.7%. 80% avaient un niveau eleve d'epuisement emotionnel, 70% avaient un niveau eleve de depersonnalisation et 17 % avaient un niveau bas de sentiment d'accomplissement personnel. Le burnout etait plus eleve chez les hommes (70,8% vs 69,4% ; p=0,013) ; ceux qui voulaient ameliorer les conditions du travail (70.2% vs. 66.7% ; p= 0.017) ; du salaire (70.2% vs. 66.7% ; p= 0.017) et chez les infirmiers suivi en psychiatrie (71.4% vs. 69.8% ; p= 0.008). CONCLUSION: Dans notre etude le niveau de burnout etait eleve chez les infirmiers prenant en charge des patients en fin de vie. Il etait associe au sexe masculin et a l'insatisfaction des conditions de travail et du salaire. D'autres etudes longitudinales sont necessaires pour suivre l'evolution de ce syndrome et mettre des strategies de prevention adequates.

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Selma Ben Nasr

Papers

Validation of the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) in Tunisian adolescents and young adults.

Reliability and validity of the Arizona sexual experiences scale-Arabic version in Tunisian patients with schizophrenia

Mental Health during COVID-19 Pandemic: The Role of Optimism and Emotional Regulation

Predictors of sleep quality in medical students during COVID-19 confinement.

High prevalence of burnout in the Tunisian units that support terminally ill patients