Development and Feasibility Testing of a Physical Activity Intervention For Youth With Anxiety and Depression: a Study Protocol

Background: Anxiety and depressive disorders in children and adolescents are highly prevalent and account for more than half of all youth psychiatric disorders. Left untreated, anxiety and depression leads to numerous detrimental outcomes, including reduced quality of life, psychiatric and somatic comorbidity and even reduced lifespan. This puts a large strain on child and adolescent mental healthcare services (CAMHS) to provide effective treatments. However, even when provided the best evidence based treatment, between 40-50 % continue to report significant symptom burdens. Thus, there is an immediate need for supplemental and/or new treatment approaches. Physical activity as a supplementary treatment may be such an approach. However, research investigating this approach within this population is scant. This protocol paper describes the development and feasibility trial of a physical activity based intervention targeting anxiety and depressive symptoms in youth treated in CAMHS.Methods/design: The study is based on the UK Medical Council Research Framework (MRC) for developing and evaluating complex interventions. Feasibility and acceptability of the physical activity intervention (Confident, Active and Happy Youth) will be evaluated in an uncontrolled open-label trial using qualitative and quantitative data. Twenty youths with anxiety and/or depressive symptoms will be recruited. Acceptability of assessment procedures, the intervention, and perceived benefits and barriers to participation will be assessed, and qualitative interviews with participants, caregivers and referring specialists will explore contextual and practical factors associated with intervention delivery. Physical activity will be measured using the Actigraph GT3X+ monitor at baseline and post-intervention and change in anxiety and depression will be assessed. Discussion: This study will contribute to the development of supplementary physical treatment interventions for youth with anxiety and depression in contact with CAMHS. The goal is to examine new avenues of treatment that ultimately may improve upon current treatment outcomes of anxiety and depression. This work will be in preparation for a future definitive RCT of this approach, in line with the MRC framework.Trial registration: ClnicalTrials.gov, NCT05049759. Registered 19 August 2021 - Retrospectively registered.

Colour Vision Disorder due to Conversion Disorders in Childhood

Background Non-organic vision loss can manifest in various ways, most commonly in the form of reduced vision and visual field defects. Colour vision disorders in the context of a conversion disorder have only rarely been reported. Materials and Methods This review presents the case of a 9-year-old boy with a colour vision disorder as the isolated symptom of a conversion disorder. The challenging in this case was an additional somatic comorbidity – a congenital red-green deficiency. Consequently it was difficult to make a diagnosis and to convince the parents. Conclusion It is important to rule out organic causes and establish the diagnosis of a conversion disorder. In these cases, multidisciplinary treatment is crucial for a successful outcome. The diagnosis may be especially challenging when the patients have both somatic and psychogenic complaints.

Multidisciplinary and differentiated approach in the treatment of psychotic disorders with comorbid somatic states

The article presents the results of a comprehensive clinical and psychopathological study of the features of clinical manifestations of psychotic patients with schizophrenia with somatic disorders. It has been proven that disorders in schizophrenia are associated with a negative clinical-psychopathological and socio-personal prognosis, leading to increase of severity of psychopathological symptoms and a decrease in the level of socio-psychological functioning. The identified features of the clinical course have become the leading target features, a system of multidisciplinary and differentiated approach in the complex therapy of patients taking into account somatic comorbidity has been developed and implemented in practice. The proposed system is a set of activities, including a combination of pharmacotherapeutic, psychoeducational, psychotherapeutic and psychosocial activities, selected taking into account the specifics of the psychopathological process modified by somatic pathology. According to the results of testing, its effectiveness has been proven, and it has been established that its use can significantly improve the condition of patients and their level of socio-psychological functioning, increase the stability of remission and reduce the number of hospitalizations.

Elevated body weight modulates subcortical volume change and associated clinical response following electroconvulsive therapy

Background: Obesity is a frequent somatic comorbidity of major depression, and it has been associated with worse clinical outcomes and brain structural abnormalities. Converging evidence suggests that electroconvulsive therapy (ECT) induces both clinical improvements and increased subcortical grey matter volume in patients with depression. However, it remains unknown whether increased body weight modulates the clinical response and structural neuroplasticity that occur with ECT. Methods: To address this question, we conducted a longitudinal investigation of structural MRI data from the Global ECT-MRI Research Collaboration (GEMRIC) in 223 patients who were experiencing a major depressive episode (10 scanning sites). Structural MRI data were acquired before and after ECT, and we assessed change in subcortical grey matter volume using FreeSurfer and Quarc. Results: Higher body mass index (BMI) was associated with a significantly lower increase in subcortical grey matter volume following ECT. We observed significant negative associations between BMI and change in subcortical grey matter volume, with pronounced effects in the thalamus and putamen, where obese participants showed increases in grey matter volume that were 43.3% and 49.6%, respectively, of the increases found in participants with normal weight. As well, BMI significantly moderated the association between subcortical grey matter volume change and clinical response to ECT. We observed no significant association between BMI and clinical response to ECT. Limitations: Because only baseline BMI values were available, we were unable to study BMI changes during ECT and their potential association with clinical and grey matter volume change. Conclusion: Future studies should take into account the relevance of body weight as a modulator of structural neuroplasticity during ECT treatment and aim to further explore the functional relevance of this novel finding.

Exploring the Relationship Between Movement Disorders and Physical Activity in Patients With Schizophrenia: An Actigraphy Study

Low physical activity (PA) and sedentary behavior (SB) are major contributors to mental health burden and increased somatic comorbidity and mortality in people with schizophrenia and related psychoses. Movement disorders are highly prevalent in schizophrenia populations and are related to impaired functioning and poor clinical outcome. However, the relationship between movement disorders and PA and SB has remained largely unexplored. Therefore, we aimed to examine the relationship between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and PA and SB in 216 patients with schizophrenia and related psychoses. Actigraphy, the St. Hans Rating Scale for extrapyramidal syndromes, and psychopathological ratings (PANSS-r) were applied. Data were analyzed using multiple linear regression, adjusting for sex, age, negative symptoms, and defined daily dose of prescribed antipsychotics. Parkinsonism was significantly associated with decreased PA (β = −0.21, P < .01) and increased SB (β = 0.26, P < .001). For dystonia, only the relationship with SB was significant (β = 0.15, P < .05). Akathisia was associated with more PA (β = 0.14, P < .05) and less SB (β = −0.15, P < .05). For dyskinesia, the relationships were non-significant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted PA (F(5,209) = 16.6, P < .001, R2Adjusted = 0.27) and SB (F(4,210) = 13.4, P < .001, R2Adjusted = 0.19). These findings suggest that movement disorders, in particular parkinsonism, are associated with reduced PA and increased SB in patients with psychotic disorders. Future studies should take movement disorders into account when examining PA and SB, to establish the clinical value of movement disorders in activating people with psychotic disorders to improve their mental and somatic health.

An approach for Risk Assessment Score of Suicide Attempt (RASSA)

Background: Suicide remains a leading cause of death and psychiatric population is often at increased risk for suicide. Therefore, there is a persistent need for well-designed clinical instruments that allows us to identify relevant risk factors. Our study aims to improve patient follow-up and identify possible suicide risk markers from a passage to self-harm among hospitalized psychiatric patients. Methods: This case-control study included the review of psychiatric, sociodemographic, drug use, and other health-related data, retrieved from 1,680 psychiatric patients’ health records. Differences between comparative groups were examined, and stepwise logistic regression analyses were performed to identify suicide risk factors within this population.Results: From the analysis of 560 suicide attempters’ clinical records, thirteen risk items were included in our final model, named as Risk Assessment Score of Suicide Attempt (RASSA). The factors that scored the highest in this model were ‘not taking antipsychotic medication’, ‘somatic comorbidity’, and ‘a family history of suicide’. Suffering from depression has a high score, and treatment with selective serotonin reuptake inhibitors (SSRIs) is also involved in the risk of a suicide attempt. Regarding medication use, opioid analgesics decreased the risk score, while taking non-opioid analgesics increased it. In terms of commonly abused substances, alcohol, cocaine, and amphetamine dependence increased the score. A higher risk was also associated with cannabis dependence, while tobacco use reduced it. As for demographics, the risk was significantly greater for women and subjects who were unmarried. Conclusions: The proposed model of risk assessment score of suicide attempt (RASSA) offers the possibility of establishing a suicide attempt risk based on data directly gathered from the health records of psychiatric patients. Therefore, it might be used as an initial screening test before patient evaluation and psychometric tests.