Journal of affective disorders
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Patients may present cognitive deficits during all stages of bipolar disorder (BD). Few studies have examined self-reported cognitive difficulties and its relation to neurocognitive dysfunction during symptomatic periods of BD. This study aimed to compare subjective cognitive functioning and explore associations between subjective and objective cognitive functioning across different BD clinical states, and investigate the predicting and moderating roles of mood symptoms. ⋯ The associations between subjective and objective cognitive dysfunction varied in clinical states, and mood symptoms moderated the associations. A neuropsychological test battery is required to substantiate actual cognitive dysfunction in clinical settings, irrespective of subjective cognitive deficits.
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The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied. ⋯ The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.
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Risk scales are used widely for assessing individuals presenting to Emergency Departments (EDs) following self-harm. There is growing evidence that risk scales have limited clinical utility in identifying episodes at highest risk of repeat self-harm. However, their cost-effectiveness in terms of treatment allocation and subsequent repeat self-harm is unknown. We aimed to examine the cost-effectiveness of five risk scales (SAD PERSONS Scale, Modified SAD PERSONS Scale, ReACT Self-Harm Rule, Manchester Self-Harm Rule, Barratt Impulsivity Scale) and single item clinician and patient ratings of risk. ⋯ The use of formal assessment tools for managing self-harm presentations to EDs did not appear to be cost-effective. While the judgement of a mental health clinician was found to be slightly more cost-effective, it still resulted in incorrect allocation of costs and missed treatment opportunities.
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Impulsivity and aggression may be associated with suicide attempts in bipolar disorder (BD), but findings have been inconsistent. Abnormalities in anterior white matter tracts that project to the frontal lobes mediate top-down regulation of emotion and may contribute to this clinical phenomenology. ⋯ Impulsivity and aggression may be risk factors for a suicide attempt in BD. White matter in the anterior limb of the internal capsule and anterior corona radiata may play a role in this phenomenology.
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Comparative Study
Comparative validity and responsiveness of PHQ-ADS and other composite anxiety-depression measures.
Composite measures that assess the overall burden of anxiety and depressive symptoms have been infrequently evaluated in the same study. The objective of this study was to compare the validity and responsiveness of the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) and other composite anxiety-depression measures. ⋯ Composite depression and anxiety scales are valid and responsive measures that may be useful as outcomes in research and clinical practice.