Psychiatry and Psychology Commons^™

Interpersonal Psychotherapy’S Problem Areas As An Organizing Framework To Understand Depression And Sexual And Reproductive Health Needs Of Kenyan Pregnant And Parenting Adolescents: A Qualitative Study, Manasi Kumar, Obadia Yator, Vincent Nyongesa, Martha Kagoya, Shillah Mwaniga, Joseph Kathono, Isaiah Gitonga, Nancy Grote, Helena Verdeli, Keng Yen Huang

Brain and Mind Institute

Background: Peripartum adolescents experience signifcant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents’ responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy’s (IPT) problem areas as a framework to understand depression.

Method: We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16–18 years (n=23) with …

In-School Adolescents’ Loneliness, Social Support, And Suicidal Ideation In Sub-Saharan Africa: Leveraging Global School Health Data To Advance Mental Health Focus In The Region, Richard Gyan Aboagye, Bright Opoku Ahinkorah, Abdul-Aziz Seidu, Joshua Okyere, James Boadu Frimpong, Manasi Kumar

Brain and Mind Institute

Introduction: Adolescent and youth mental health problems are increasingly becoming an area of concern in global health. Young people in sub-Saharan Africa experience significant adversities and systemic challenges despite technological advancements and demographic transition that the region is experiencing. We examined the nexus between experiences of loneliness, low social support, and presence of suicidal ideation among in-school adolescents in sub-Saharan Africa.

Method: A total of 19,119 in-school adolescents from eight countries in sub-Saharan Africa were included in this study. Suicidal ideation was the main outcome variable and loneliness, and social support were the explanatory variables. Percentages were used to summarise …

The Burden Of Injury In Central, Eastern, And Western European Sub-Region: A Systematic Analysis From The Global Burden Of Disease 2019 Study, Periklis Charalampous, Juanita A. Haagsma, Filippo Ariani, Anne Gallay, Kim Moesgaard Iburg, Evangelia Nena, Che Henry Ngwa, Alexander Rommel, Ausra Zelviene, Manasi Kumar

Brain and Mind Institute

Abstract: Background: Injury remains a major concern to public health in the European region, particularly among adults younger than 49 years. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) …

Depression And Its Associated Factors: Perceived Stress, Social Support, Substance Use And Related Sociodemographic Risk Factors In Medical School Residents In Nairobi, Kenya, Sayed Shah Nur Hussein Shah, Ahmed Laving, Violet Caroline Okech-Helu, Manasi Kumar

Brain and Mind Institute

Abstract: Background: Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya’s largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment. …

Mapping Services At Two Nairobi County Primary Health Facilities: Identifying Challenges And Opportunities In Integrated Mental Health Care As A Universal Health Coverage (Uhc) Priority, Manasi Kumar, Vincent Nyongesa, Martha Kagoya, Byamah B. Mutamba,, Beatrice Amugune, Neha S. Krishnam, Grace Nduku Wambua, Inge Petersen, Onesmus Gachuno, Shekhar Saxena

Brain and Mind Institute

Abstract: Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground.

Method and measures This study utilized a qualitative evidence synthesis through …

Routine Outcome Measurement In Adolescents Seeking Mental Health Services: Standardization Of Honosca In Kenyan Sample, Grace Nduku Wambua, Manasi Kumar, Fredrik Falkenström, Pim Cuijpers

Brain and Mind Institute

Abstract: Background The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya.

Methods Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) …

Mental Health Service Preferences Of Patients And Providers: A Scoping Review Of Conjoint Analysis And Discrete Choice Experiments From Global Public Health Literature Over The Last 20 Years (1999–2019), Anna Larsen, Albert Tele, Manasi Kumar

Brain and Mind Institute

Abstract: Background: In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients’ needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers. Methods: We performed a scoping review from the past 20 years (2009–2019) to identify and describe applications …

Is There An Optimal Screening Tool For Identifying Perinatal Depression Within Clinical Settings Of Sub-Saharan Africa?, Anna Larsen, Jillian Pintye, Amritha Bhat, Manasi Kumar, John Kinuthia, Pamela Y. Collins, Grace John Stewart

Brain and Mind Institute

Abstract: Depression is a leading cause of maternal morbidity and mortality worldwide and the most common complication of the perinatal period. Women in sub-Saharan Africa (SSA) are disproportionately impacted by perinatal depression. Maternal and child health (MCH) clinics are widely attended in SSA, offering a potential access point for depression screening. Yet, selection of optimal depression screening instruments for use within MCH clinics in SSA remains unclear. We synthesized evidence depicting relative strength of perinatal depression screening scales for use among African perinatal women within four evaluation domains: 1) diagnostic performance, 2) cultural adaptation, 3) feasibility and ease of implementation, …

Use Of Multidimensional Item Response Theory Methods For Dementia Prevalence Prediction: An Example Using The Health And Retirement Survey And The Aging, Demographics, And Memory Study, Manasi Kumar, Gbd 2019 Dementia Collaborators

Brain and Mind Institute

Abstract: Background: Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation samples from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally. Methods: Using cognitive testing data and data on functional limitations from Wave A (2001–2003) of the ADAMS study (n=744) and the 2000 wave of the HRS study (n=6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all individuals over 70. Based on diagnostic information …

Search For Dark Matter Produced In Association With A Standard Model Higgs Boson Decaying Into B-Quarks Using The Full Run 2 Dataset From The Atlas Detector, Georges Aad, B Abbott, Dc Abbott, A Abed Abud, Kira Abeling, Deshan Kavishka Abhayasinghe, Sh Abidi, Os Abouzeid, Halina Abramowic, Manasi Kumar

Brain and Mind Institute

Abstract: The production of dark matter in association with Higgs bosons is predicted in several extensions of the Standard Model. An exploration of such scenarios is presented, considering final states with missing transverse momentum and b-tagged jets consistent with a Higgs boson. The analysis uses proton-proton collision data at a centre-of-mass energy of 13 TeV recorded by the ATLAS experiment at the LHC during Run 2, amounting to an integrated luminosity of 139 fb−1 . The analysis, when compared with previous searches, benefits from a larger dataset, but also has further improvements providing sensitivity to a wider spectrum of signal …

The Path To Global Equity In Mental Health Care In The Context Of Covid-19, Lola Kola, Brandon A. Kohrt, Bibhav Acharya, Byamah B. Mutamba, Christian Kieling, Manasi Kumar, Charlene Sunkel, Wufang Zhang, Charlotte Hanlon

Brain and Mind Institute

The theme of the 2021 World Mental Health Day is “Mental Health in an Unequal World”, highlighting unequal access to mental health care across the world. This situation has been further worsened by governmental and public responses to the COVID-19 pandemic. The response of many high-income countries (HICs) and institutions to the pandemic has been the reverse of equity, exemplified by inequitable access to COVID-19 vaccines and widening inequities in wealth.1 A crucial consideration in this context is the imbalance in social and economic factors that shape onset and outcomes of mental health across communities and countries.2 Looking through a …

Global, Regional, And National Mortality Among Young People Aged 10–24 Years, 1950–2019: A Systematic Analysis For The Global Burden Of Disease Study 2019, Joseph L. Ward, Peter S S. Azzopardi, Kate Louise Francis, John S S. Santelli, Vegard Skirbekk, Susan M. Sawyer, Nicholas J. Kassebaum, Ali H. Mokdad, Simon I. Hay, Manasi Kumar

Brain and Mind Institute

Summary: Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality …

Using Heart Rate Profiles During Sleep As A Biomarker Of Depression, Mysa Saad, Laura B. Ray, Brad Bujaki, Amir Parvaresh, Iryna Palamarchuk, Joseph De Koninck, Alan Douglass, Elliott K. Lee, Louis J. Soucy, Zul Merali

Brain and Mind Institute

Background: Abnormalities in heart rate during sleep linked to impaired neuro-cardiac modulation may provide new information about physiological sleep signatures of depression. This study assessed the validity of an algorithm using patterns of heart rate changes during sleep to discriminate between individuals with depression and healthy controls.

Methods: A heart rate profiling algorithm was modeled using machine-learning based on 1203 polysomnograms from individuals with depression referred to a sleep clinic for the assessment of sleep abnormalities, including insomnia, excessive daytime fatigue, and sleep-related breathing disturbances (n = 664) and mentally healthy controls (n = 529). The final algorithm …

Liaison Psychiatry Services In Wales, Tayyeb Tahir, Adam Watkins, Philip Slack

Brain and Mind Institute

Aims and method: Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.

Results: Over the past 2 years, liaison psychiatry services have been set up in six out of …

Clozapine Is Associated With Secondary Antibody Deficiency, Mark Ponsford, Daniel Castle, Tayyeb Tahir, Rebecca Robinson, Wendy Wade, Rachael Steven, Kathryn Bramhall, Mo Moody Mo Moody, Emily Carne, Catherine Ford

Brain and Mind Institute

Background: Schizophrenia affects 1% of the population. Clozapine is the only medication licensed for treatment-resistant schizophrenia and is intensively monitored to prevent harm from neutropenia. Clozapine is also associated with increased risk of pneumonia although the mechanism is poorly understood.AimsTo investigate the potential association between clozapine and antibody deficiency.

Methods: Patients taking clozapine and patients who were clozapine-naive and receiving alternative antipsychotics were recruited and completed a lifestyle, medication and infection-burden questionnaire. Serum total immunoglobulins (immunoglobulin (Ig)G, IgA, IgM) and specific IgG antibodies to haemophilus influenzae type B, tetanus and IgG, IgA and IgM to pneumococcus were measured.

Results: Immunoglobulins …

Palatable Food Dampens The Long-Term Behavioral And Endocrine Effects Of Juvenile Stressor Exposure But May Also Provoke Metabolic Syndrome In Rats, Eliza Fatima Ali, Jennifer Christine Mackay, Samantha Graitson, Jonathan Stewart James, Christian Cayer, Marie-Claude Audet, Pamela Kent, Alfonso Abizaid, Zul Premji

Brain and Mind Institute

The juvenile period is marked by a reorganization and growth of important brain regions including structures associating with reward seeking behaviors such as the nucleus accumbens (NA) and prefrontal cortex (PFC). These changes are impacted by stressors during the juvenile period and may lead to a predisposition to stress induced psychopathology and abnormal development of brain reward systems. Like in humans, adult rodents engage certain coping mechanisms such as increases in the consumption of calorie-rich palatable foods to reduce stress, but this behavior can lead to obesity and metabolic disorders. In this study, we examined whether stressors during the juvenile …

Loss Of Mecp2 In Adult 5-Ht Neurons Induces 5-Ht1a Autoreceptors, With Opposite Sex-Dependent Anxiety And Depression Phenotypes, Tristan J. Philippe, Faranak Vahid-Ansari, Zoe R. Donaldson, Brice Le François, Amin Zahrai, Valérie Turcotte-Cardin, Mireille Daigle, Jonathan James, René Hen, Zul Merali, Paul R. Albert

Brain and Mind Institute

The 5-HT1A autoreceptor mediates feedback inhibition of serotonin (5-HT) neurons, and is implicated in major depression. The human 5-HT1A gene (HTR1A) rs6295 risk allele prevents Deaf1 binding to HTR1A, resulting in increased 5-HT1A autoreceptor transcription. Since chronic stress alters HTR1A methylation and expression, we addressed whether recruitment of methyl-binding protein MeCP2 may alter Deaf1 regulation at the HTR1A locus. We show that MeCP2 enhances Deaf1 binding to its HTR1A site and co-immunoprecipitates with Deaf1 in cells and brain tissue. Chromatin immunoprecipitation assays showed Deaf1-dependent recruitment of MeCP2 to the mouse HTR1A promoter, and MeCP2 modulated human and mouse HTR1A gene …

The Mini-Mental State Examination As A Diagnostic And Screening Test For Delirium: Systematic Review And Meta-Analysis, Alex J. Mitchell, Deepak Shukla, Hafsa A. Ajumal, Brendon Stubbs, Tayyeb Tahir

Brain and Mind Institute

Objective

To analyse the evidence concerning the accuracy of the Mini-Mental State Examination (MMSE) as a diagnostic and screening test for the presence of delirium in adults.

Method

Two authors searched MEDLINE, PsychINFO and EMBASE from inception till March 2014. Articles were included that investigated the diagnostic validity of the MMSE to detect delirium against standardised criteria. A diagnostic validity meta-analysis was conducted.

Results

Thirteen studies were included representing 2017 patients in medical settings of whom 29.4% had delirium. The meta-analysis revealed the MMSE had an overall sensitivity and specificity estimate of 84.1% and 73.0%, but this was 81.1% and …

Protracted Effects Of Juvenile Stressor Exposure Are Mitigated By Access To Palatable Food, Jennifer Christine Mackay, Jonathan Stewart James, Christian Cayer, Pamela Kent, Hymie Anisman, Zul Merali

Brain and Mind Institute

Stressor experiences during the juvenile period may increase vulnerability to anxiety and depressive-like symptoms in adulthood. Stressors may also promote palatable feeding, possibly reflecting a form of self-medication. The current study investigated the short- and long-term consequences of a stressor applied during the juvenile period on anxiety- and depressive-like behavior measured by the elevated plus maze (EPM), social interaction and forced swim test (FST). Furthermore, the effects of stress on caloric intake, preference for a palatable food and indices of metabolic syndrome and obesity were assessed. Male Wistar rats exposed to 3 consecutive days of variable stressors on postnatal days …

Molecular Pathway Reconstruction And Analysis Of Disturbed Gene Expression In Depressed Individuals Who Died By Suicide, Vladimir Zhurov, John D. H. Stead, Zul Merali, Miklos Palkovits, Gabor Faludi, Caroline Schild-Poulter, Hymie Anisman, Michael O. Poulter

Brain and Mind Institute

Molecular mechanisms behind the etiology and pathophysiology of major depressive disorder and suicide remain largely unknown. Recent molecular studies of expression of serotonin, GABA and CRH receptors in various brain regions have demonstrated that molecular factors may contribute to the development of depressive disorder and suicide behaviour. Here, we used microarray analysis to examine the expression of genes in brain tissue (frontopolar cortex) of individuals who had been diagnosed with major depressive disorder and died by suicide, and those who had died suddenly without a history of depression. We analyzed the list of differentially expressed genes using pathway analysis, which …

A Randomized Controlled Trial Of Quetiapine Versus Placebo In The Treatment Of Delirium, Tayyeb Tahir, Eamonn Eeles, Venugopal Karapareddy, Prem Muthuvelu, Sian Chapple, Bethan Phillips, Toyin Adyemo, Daniel Farewell, Jonathan I. Bisson

Brain and Mind Institute

Background

Delirium is a commonly occurring complex neuropsychiatric disorder. Evidence for its treatment based on randomized controlled trials (RCTs) is poor.

Aims

To determine the efficacy and acceptability of quetiapine in the treatment of delirium.

Method

A double-blind, RCT was conducted. A total of 42 patients were randomized to quetiapine or a placebo group. The primary outcome measure was the Delirium Rating Scale Revised 98. Other scales used were the Brief Psychiatric Rating Scale, Mini-Mental State Examination and Clinical Global Improvement. In order to account for missing data, a nonlinear mixed-effects model was used to estimate the difference …