Notes

Towards a Harm-Based Consideration associated with Microaggressions.
Background Prevalence estimates of Bipolar Spectrum Disorders (BSD) remain scant in Southeast Asia. This study aims to investigate the prevalence of BSD, its correlates with sociodemographic factors, and the associations between the BSD subgroups and clinical severity, impairment, and disability in Singapore. Methods This study utilizes data gathered from the second Singapore Mental Health Study (SMHS)- a nationwide cross-sectional survey conducted between 2016 and 2018 (response rate 69.5%). Respondents were randomly selected and administered, in a single visit, interviewer-led surveys of the World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) in their preferred language (i.e. Chinese, Malay, Tamil, or English). A total of 6126 residents completed the study. Results The lifetime weighted prevalence of BSD, Bipolar I, II, and subthreshold bipolar disorder was 3.1%, 1.5%, 0.03%, and 1.6% respectively. A higher prevalence of Bipolar Disorders (BPD) was significantly associated with younger age, being divorced or separated, and being unemployed. Lifetime comorbidity of BSD with at least one other psychiatric or physical condition was 45% and 51% respectively. BSD was most comorbid with Obsessive Compulsive Disorder (psychiatric condition) and Chronic pain (physical condition). Limitations This study relies on self-report data which may be subject to unintended response biases leading to the under or over-reporting of results. Discussion In addition to the high prevalence of BPD, there is also a concerning shift and increase in the proportion of those who experience severe symptoms of mania/hypomania and depression. Subthreshold bipolar disorder is found to be clinically significant and cross-culturally valid in a multi-cultural setting.Background Major depressive disorder (MDD) has been implicated as a risk factor for various immune-related disorders; however, the association between MDD and subsequent autoimmune skin diseases (ASDs) remains unclear. This study aimed to investigate the association of MDD with risk of subsequent ASDs. Methods Subjects were recruited from the National Health Insurance Research Database in Taiwan. We included 222,522 patients with MDD and 890,088 matched controls to assess the risk of developing ASDs. Results After controlling for confounders, we found an increased risk of ASDs among the patients with MDD (adjusted hazard ratio [aHR], 10.41; 95% CI, 9.62-11.42) compared to matched controls. Subgroup analyses showed that MDD patients had a significantly increased risk of developing psoriasis (aHR, 12.01; 95% CI, 10.37-13.91), lichen planus (aHR, 11.84; 95% CI, 8.90-15.75), alopecia areata (aHR, 11.61; 95% CI, 9.92-13.59), morphea (aHR, 6.03; 95% CI, 2.47-14.73), autoimmune bullous diseases (aHR, 7.67; 95% CI, 5.94-9.90), hidradenitis suppurativa (aHR, 8.45; 95% CI, 3.61-19.74), vitiligo (aHR, 7.24; 95% CI, 5.65-9.28), lupus erythematosus (aHR, 11.30; 95% CI, 9.21-13.86), systemic sclerosis (aHR, 8.07; 95% CI, 4.30-15.14), Sjogren's syndrome (aHR, 6.71; 95% CI, 5.29-8.50), and dermatomyositis (aHR, 14.44; 95% CI, 5.55-37.55). Conclusions Patients with MDD had an increased risk of developing ASDs as compared to the controls. Further studies are needed to better understand the underlying mechanisms.Background Current evidence on the associations between different types of milk products and depressive symptoms is few and controversial, and there has been no study focusing on different types of milk (whole-fat, low-fat, and skim). This study aimed to appraise their associations. Methods This cross-sectional study included adults (N=21,924) from the National Health and Nutrition Examination Survey 2007-2016. Patient Health Questionnaire was used to evaluate depressive symptoms. Logistic regression model was implemented to assess the association of dairy consumption with depressive symptoms. Results After multivariate adjustment, compared to non-consumers, the odds ratios (95% confidence intervals) of depressive symptoms for intake less then 175.38 g/d and 175.38 to less then 321.56 g/d of skim milk were 0.48 (0.27-0.85) and 0.46 (0.29-0.75), and 0.70 (0.55-0.88) for intake less then 81.00 g/d of milk desserts, while 1.61 (1.05-2.46), 1.70 (1.15-2.50) and 1.55 (1.11-2.16) for intake less then 129.63 g/d, 129.63 to less then 289.75 g/d and ≥ 289.75 g/d of whole milk, respectively. These associations remained significant in stratified analyses by gender and age. Additionally, yogurt was negatively associated with depressive symptoms in both females and the age group (≥ 60 years). Low-fat milk was inversely associated with depressive symptoms for both males and the age group (≥ 60 years). Moderate creams intake was negatively associated with depressive symptoms in males. Limitations It was difficult to infer causality for a cross-sectional study. Conclusions Intakes of skim milk and moderate milk desserts were negatively associated with depressive symptoms, while whole milk was positively associated with depressive symptoms among adults.Background To investigate the effects of stepwise pharmacotherapy based on early clinical decision-making on short- and long-term treatment outcomes in outpatients with depressive disorders in a naturalistic one-year prospective design. Methods Patients were recruited at a University hospital in South Korea from March 2012 to April 2017. At baseline, 1262 patients received antidepressant monotherapy. For patients with an insufficient response or uncomfortable side effects, next treatment steps (1, 2, 3, and 4 or over) with alternative strategies (switching, augmentation, combination, and mixtures of these approaches) were administered considering measurements and patient preference at every 3 weeks in the acute treatment phase (3, 6, 9, and 12 weeks) (N=1246), and at every 3 months in the continuation treatment phase (6, 9, and 12 months) (N=1015). Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7. Results Remission was more frequently achieved with increasing treatment steps and advanced treatment strategies over the treatment period, while the superior effect of treatment Step 4 or over no longer persisted in the continuation treatment phase. Augmentation + combination strategy was associated with the best outcome, with least benefit associated with a switching strategy compared to monotherapy continuation. Adverse events were more frequent with increasing treatment steps and advanced treatment strategies, while numbers of visits did not statistically differ by treatment steps or strategies. Limitation The lack of a comparison group without early clinical decision due to the descriptive nature of study design limits to prove directly the study question. Conclusions A stepwise pharmacotherapy approach based on early clinical decision-making in the light of measurements and patient preference could enhance both short- and long-term treatment outcomes in depressive disorders.Background The pathogenetic mechanisms of Bipolar Disorder (BD) have not been totally clarified. Oxidative stress seems to be involved in the etiology of BD, and malondialdehyde (MDA) represents a candidate biomarker for monitoring this aspect in different medical conditions including mood disorders. This article has the objective to critically summarize the available data about the association between MDA and BD. Methods A research in Pubmed, PsycINFO and Isi Web of Knowledge was fulfilled to identify studies in which MDA levels were measured in BD patients for the purpose of securing a comprehensive review concerning the issue. Results We detected 20 articles that satisfied the inclusion criteria most of them observed higher MDA levels (or Thiobarbituric acid-reactive substances-TBARS) in BD patients compared to healthy controls (HC), although there are some contrasting results, depending in particular on the phase of illness or the inclusion criteria or the methodological differences. Limitations We included studies, exclusively in English, that used different laboratory methods to measure MDA. Conclusions The analysed articles suggest that MDA or TBARS are increased in BD patients with respect to HC, thus supporting the hypothesis that MDA may be a promising and potential biomarker to monitor the course of BD, although further studies are needed to confirm this hypothesis.Background Limited studies have been conducted to investigate the mental health status of subgroups of university students. This study hypothesized that there would be differences among student subgroups in the prevalence of depression, anxiety and stress; and association of age, gender, academic performance and mental health status. Methods This was a cross-sectional survey study. Since 2014, first-year university students in a university in Hong Kong were invited to complete the Depression Anxiety Stress Scale (DASS-21) before the commencement of their study. These DASS data were then merged with objectively measured data from university records. 9,479 students completed the DASS survey, this being 56.5% of the total student population in the records. Kruskal-Wallis Tests were applied to compare the differences among student subgroups. Results Community college transfer (CCT) students were the highest-risk group for depression, anxiety and stress, and their study load was the highest as well. Unexpectedly, mainstream students ranked after the CCT students in the prevalence and levels of depression, anxiety and stress. Student athletes had the highest prevalence of depression. Although there were declining trends for depression, anxiety and stress, it was only a slight drop. Overall, age, gender, study load and academic performance were associated with the mental health profile (p less then 0.05). Limitations After admission, students' mental health conditions could have changed. Further studies are needed to measure mental health during their study. Conclusions Mental health problems were not distributed evenly across different student subgroups, psychological support should be designed according to the needs of each student subgroup.Background Many individuals use cannabis to manage symptoms of post-traumatic stress disorder (PTSD), and evidence indicates that the endocannabinoid system represents a viable target for treating these symptoms. Method Data from 404 medical cannabis users who self-identified as having PTSD were obtained from Strainprint®, a medical cannabis app that patients use to track changes in symptoms as a function of different strains and doses of cannabis across time. This sample collectively used the app 11,797 times over 31 months to track PTSD-related symptoms (intrusive thoughts, flashbacks, irritability, and/or anxiety) immediately before and after inhaling cannabis. Latent change score models were used to examine changes in symptom severity and predictors of these changes (gender, dose, cannabis constituents, time). Multilevel models were used to explore long-term consequences of repeatedly using cannabis to manage these symptoms. Results All symptoms were reduced by more than 50% immediately after cannabis use. Time predicted larger decreases in intrusions and irritability, with later cannabis use sessions predicting greater symptom relief than earlier sessions. Higher doses of cannabis predicted larger reductions in intrusions and anxiety, and dose used to treat anxiety increased over time. Baseline severity of all symptoms remained constant across time. T-DM1 in vivo Limitations The sample was self-selected, self-identified as having PTSD, and there was no placebo control group. Conclusions Cannabis provides temporary relief from PTSD-related symptoms. However, it may not be an effective long-term remedy as baseline symptoms were maintained over time and dose used for anxiety increased over time, which is indicative of development of tolerance.
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