Escitalopram in the prevention of posttraumatic stress disorder: a pilot randomized controlled trial

Background: A small literature suggests that pharmacotherapy may be useful in the prophylaxis of posttraumatic stress disorder in patients presenting with major trauma. There is relatively little data, however, on the use of selective serotonin reuptake inhibitors (SSRIs) in this context. Methods: 24 week, double-blind placebo controlled study. 31 participants presenting immediately after trauma, and meeting diagnostic criteria for full or partial acute stress disorder were randomized to treatment with 10–20 mg of escitalopram or placebo daily for 24 weeks. 2 participants were excluded from the analysis due to early drop out, leaving 29 participants (escitalopram = 12, placebo = 17) for inclusion in an intent- to- treat analysis. Participants were followed up until 56 weeks, and assessed with the Clinician Administered PTSD Scale (CAPS). A mixed model repeated measures analysis of variance (RMANOVA) was undertaken to determine the efficacy of the intervention on the CAPS score. Results: There was a significant reduction in CAPS score over the course of treatment (F(7, 142) = 41. 58, p < 0.001) in both the escitalopram and placebo groups, with a greater reduction in CAPS score in the placebo group F(7, 142) = 2.12, p = 0.045. There were improvements on all secondary measures, including the Clinical Global Impressions scale, and scales assessing depression, anxiety and disability. Only functional disability outcomes (F(7, 141) = 2.13, p = .04), were significantly different between treatment and placebo groups. In the sample as a whole, improvement in scores were maintained at the 52 week follow-up. Side effects were comparable between the groups. Conclusions: These data are consistent with other recent work indicating that the SSRIs may not be efficacious in the prevention of PTSD. Nevertheless, the small sample size and baseline differences between groups limit the explanatory power of the study. Although a consideration of the possibility of medication prophylaxis in PTSD remains important, both from conceptual and clinical perspectives, caution is needed with regards to the use of SSRIs until their efficacy can be proven. Trial registration: Clinical Trials NCT0030031

Sleep quality and neurocognitive functioning in metabolic syndrome

Background: The incidence of metabolic syndrome (MetS), a cluster of metabolic risk factors in a single individual, is increasing worldwide, making it important to study the possible risk and protective factors. Accumulating evidence has suggested sleep deprivation and/or fragmentation is among the key factors involved in the onset and treatment resistance of MetS components. Moreover, bidirectional associations between sleep complaints and MetS have been described. In addition, there is mounting evidence of the effect of MetS on cognitive functioning. Aims: The aim of this study was to assess whether MetS and sleep complaints are associated with clinically determined neurocognitive disturbances in a sample of participants with MetS symptoms, ranging from none to all criteria met. Methods: Participants comprised 153 mixed race individuals from the Western Cape province of South Africa. Sleep (Pittsburgh Sleep Quality Index), neurocognition (Repeatable Battery for the Assessment of Neuropsychological Status) and anthropometric (MetS components) assessments were performed on all participants. A hierarchical regression model, including potentially confounding variables (e.g. IQ), demographic variables (e.g. age and gender) and clinical variables (e.g. [BMI] and cholesterol), was then constructed. Results: The model was significant: adjusted R square = 0.486; F(13, 110) = 9.952, p < 0.0001. The demographic variables accounted for 32.3% of variability. This increased to 48.5% when the clinical variables were added. Sleep and metabolic criteria only added 0.1%. Discussion: Although we did not find sleep and metabolic factors to significantly influence cognition when other factors were accounted for, further investigation into risk and outcome factors, such as these, may assist in the identification of mechanistic links, which may also improve management of patients who are at risk, thereby improving health outcomes

The prevalence of mental health problems in sub-saharan adolescents : a systematic review

Background and purpose Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. Methods A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer's manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10-19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. Results The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.Hochschule für Angewandte Wissenschaften HamburgPeerReviewe

Development of a mobile application for detection of adolescent mental health problems and feasibility assessment with primary health care workers

INTRODUCTION : There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. METHODS : Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. RESULTS : The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. CONCLUSION : HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.Erasmus + Capacity Building.https://www.tandfonline.com/loi/imhn20hj2023Psychiatr

Design and development process of a youth depression screening m-health application for primary health care workers in South Africa and Zambia : an overview of the MEGA project

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.http://www.tandfonline.com/loi/imhn20hj2020Psychiatr

Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation

<p>Abstract</p> <p>Background</p> <p>The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks, however some studies have documented psychological distress in the form of posttraumatic stress disorder and depression in the aftermath of termination. Choice of anaesthetic has been suggested as a determinant of outcome. This study compared the effects of local anaesthesia and intravenous sedation, administered for elective surgical termination, on outcomes of pain, cortisol, and psychological distress.</p> <p>Methods</p> <p>155 women were recruited from a private abortion clinic and state hospital (mean age: 25.4 ± 6.1 years) and assessed on various symptom domains, using both clinician-administered interviews and self-report measures just prior to termination, immediately post-procedure, and at 1 month and 3 months post-procedure. Morning salivary cortisol assays were collected prior to anaesthesia and termination.</p> <p>Results</p> <p>The group who received local anaesthetic demonstrated higher baseline cortisol levels (mean = 4.7 vs 0.2), more dissociative symptoms immediately post-termination (mean = 14.7 vs 7.3), and higher levels of pain before (mean = 4.9 vs 3.0) and during the procedure (mean = 8.0 vs 4.4). However, in the longer-term (1 and 3 months), there were no significant differences in pain, psychological outcomes (PTSD, depression, self-esteem, state anxiety), or disability between the groups. More than 65% of the variance in PTSD symptoms at 3 months could be explained by baseline PTSD symptom severity and disability, and post-termination dissociative symptoms. Of interest was the finding that pre-procedural cortisol levels were positively correlated with PTSD symptoms at both 1 and 3 months.</p> <p>Conclusion</p> <p>High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.</p

Assessing post-traumatic responses among South African adolescents : a comparison of different methods

Bibliography: leaves 87-101.The present study compares the use of standardised diagnostic clinical interviews, self-report scales, and unstructured interviews, to determine if these different methods of assessment elicit the same or similar information with regards to trauma exposure, post-traumatic stress disorder, and depression in adolescents. A sample of Grade ll learners was drawn from two schools in the Northern Suburbs of Cape T own. The total sample comprised of 58 learners between the ages of 16 and 18 years. Each participant was administered a demographic questionnaire, a clinical diagnostic interview, two self-report scales, and an unstructured interview. The diagnostic interview used was the Schedule for Affective Disorders and Schizophrenia for School-Aged Children - Present and Lifetime version (K-SADS-PL), and the self- report scales used were the Child and Adolescent Trauma Survey (CATS) and the Children's Depression Inventory (CD1). The demographic questionnaire and qualitative interview were devised for the study. The McNemar Chi-Square statistic was used to determine differences between the interview and self-report methods of assessment, and a content analysis of the qualitative interview was conducted. Additionally, a Receiver Operating Characteristic analysis was used to establish a CATS score, indicating a high risk of PTSD, that was more sensitive to the sample. The results indicate that even though clinical interviews and self-report scales appear to produce different information, if appropriate cut-off points are used, self-report scales can be used as a screening device to reduce the number of clinical interviews required, thus contributing to a more efficient use of resources. They also indicate that unstructured qualitative interviews can elicit useful information about post- traumatic responses that is not captured by the DSM IV criteria

Clinical and neuropsychological predictors of posttraumatic stress disorder

Publication of this article was funded by the Stellenbosch University Open Access FundThe original publication is available at http://www.md-journal.comPlease cite as follows:Suliman, S., Stein, D. J., & Seedat, S. 2014. Clinical and neuropsychological predictors of posttraumatic stress disorder. Medicine, 93(22), doi:10.1097/MD.0000000000000113.Abstract: Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity. One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD. Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive. These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.http://www.md-journal.comAlthough acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity. One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD. Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive. These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.Publishers' versio

Brain-derived neurotrophic factor (BDNF) protein levels in anxiety disorders : systematic review and meta-regression analysis

Publication of this article was funded by the Stellenbosch University Open Access Fund.The original publication is available at http://www.frontiersin.org/Integrative_NeuroscienceBackground: Brain-Derived Neurotrophic Factor (BDNF) is a neurotrophin that is involved in the synaptic plasticity and survival of neurons. BDNF is believed to be involved in the pathogenesis of several neuropsychiatric disorders. As findings of BDNF levels in anxiety disorders have been inconsistent, we undertook to conduct a systematic review and meta-analysis of studies that assessed BDNF protein levels in these disorders. Methods: We conducted the review using electronic databases and searched reference lists of relevant articles for any further studies. Studies that measured BDNF protein levels in any anxiety disorder and compared these to a control group were included. Effect sizes of the differences in BDNF levels between anxiety disorder and control groups were calculated. Results: Eight studies with a total of 1179 participants were included. Initial findings suggested that BDNF levels were lower in individuals with any anxiety disorder compared to those without [Standard Mean Difference (SMD) = −0.94 (−1.75, −0.12), p≤0.05]. This was, however, dependent on source of BDNF protein [plasma: SMD =−1.31 (−1.69, −0.92), p≤0.01; serum: SMD = −1.06 (−2.27, 0.16), p≥0.01] and type of anxiety disorder [PTSD: SMD = −0.05 (−1.66, 1.75), p≥0.01; OCD: SMD = −2.33 (−4.21, −0.45), p≤0.01]. Conclusion: Although BDNF levels appear to be reduced in individuals with an anxiety disorder, this is not consistent across the various anxiety disorders and may largely be explained by the significantly lowered BDNF levels found in OCD. Results further appear to be mediated by differences in sampling methods. Findings are, however, limited by the lack of research in this area, and given the potential for BDNF as a biomarker of anxiety disorders, it would be useful to clarify the relationship further.Stellenbosch UniversityPublishers' versio