Mood Disorders (Psychology)

IMPORTANCE Alterations in multiple neuroimaging phenotypes have been reported in psychotic disorders. However, neuroimaging measures can be influenced by factors that are not directly related to psychosis and may confound the interpretation of case-control differences. Therefore, a detailed characterization of the contribution of these factors to neuroimaging phenotypes in psychosis is warranted. OBJECTIVE To quantify the association between neuroimaging measures and behavioral, health, and demographic variables in psychosis using an integrated multivariate approach. DESIGN, SETTING, AND PARTICIPANTS This imaging study was conducted at a university research hospital from June 26, 2014, to March 9, 2017. High-resolution multimodal magnetic resonance imaging data were obtained from 100 patients with schizophrenia, 40 patients with bipolar disorder, and 50 healthy volunteers; computed were cortical thickness, subcortical volumes, white matter fractional anisotropy, task-related brain activation (during working memory and emotional recognition), and resting-state functional connectivity. Ascertained in all participants were nonimaging measures pertaining to clinical features, cognition, substance use, psychological trauma, physical activity, and body mass index. The association between imaging and nonimaging measures was modeled using sparse canonical correlation analysis with robust reliability testing. MAIN OUTCOMES AND MEASURES Multivariate patterns of the association between nonimaging and neuroimaging measures in patients with psychosis and healthy volunteers. RESULTS The analyses were performed in 92 patients with schizophrenia (23 female [25.0%]; mean [SD] age, 27.0 [7.6] years), 37 patients with bipolar disorder (12 female [32.4%]; mean [SD] age, 27.5 [8.1] years), and 48 healthy volunteers (20 female [41.7%]; mean [SD] age, 29.8 [8.5] years). The imaging and nonimaging data sets showed significant covariation (r = 0.63, P < .001), which was independent of diagnosis. Among the nonimaging variables examined, age (r = −0.53), IQ (r = 0.36), and body mass index (r = −0.25) were associated with multiple imaging phenotypes; cannabis use (r = 0.23) and other substance use (r = 0.33) were associated with subcortical volumes, and alcohol use was associated with white matter integrity (r = −0.15). Within the multivariate models, positive symptoms retained associations with the global neuroimaging (r = −0.13), the cortical thickness (r = −0.22), and the task-related activation variates (r = −0.18); negative symptoms were mostly associated with measures of subcortical volume (r = 0.23), and depression/anxiety was associated with measures of white matter integrity (r = 0.12). CONCLUSIONS AND RELEVANCE Multivariate analyses provide a more accurate characterization of the association between brain alterations and psychosis because they enable the modeling of other key factors that influence neuroimaging phenotypes.

Recently, seven single nucleotide polymorphisms (SNPs) of ARNTL, TIM and PER3 genes were found associated with affective temperaments in bipolar disorder patients. This study aimed to test whether a) the same associations appear in a non-clinical sample; b) the SNPs are related to other affective dimensions; c) the SNPs underpin the associations between chronotype and affective temperaments/dimensions. Three hundred thirty-eight university students completed the Temperament Scale of Memphis, Pisa, Paris and San Diego Auto-questionnaire, the Centre for Epidemiological Studies Depression Scale, the Perceived Stress Scale, the General Health Questionnaire, the Seasonal Pattern Assessment Questionnaire and the Composite Scale of Morningness. Seven SNPs of the ARNTL, TIM and PER3 genes were genotyped. According to nominal significance ARNTL rs7107287 was associated with a cyclothymic temperament, depressive and stress symptoms, general mental health and perceived negative impact of seasonality, while TIM rs10876890 was associated with a hyperthymic temperament and the TIM rs2291738 was associated with chronotype. Different SNPs were related to chronotype and affective temperaments/dimensions and therefore they seem to not underpin relationships between chronotype and affective dysfunction, i.e. in the present study eveningness was related to dysthymic, cyclothymic and irritable temperaments, more symptoms of depression, stress, worse mental health and a negative impact of seasonality, while morningness was related to hyperthymic temperament. The SNPs associations need further replication given that they did not achieve Bonferroni criteria of significance accounting for the number of polymorphisms considered and tests conducted.

In the last few years a number of researchers have pointed out that the seriousness of mood disorders among preschool and primary school children is still underestimated when compared to the seriousness of the same illness during adolescence and adulthood (Luby, 2009). In spite of that, many pupils are still not diagnosed and treated. Without any treatment, this illness can lead to severe psychiatric problems in future adolescents and adults who suffered from it during their childhood (Carretti et al., 2009; Muratori, 2008; Muratori & Apicella, 2008).
The objective of this work is threefold: firstly, to describe the principal symptoms of mood disorders in order to help preschool and primary school teachers to clearly recognise them; secondly, to describe the treatments which psychologists and psychiatrists are using nowadays to treat young children affected by this illness. Finally, as educators, we would like to suggest two programmes which include a close cooperation between clinicians and teachers themselves. The former is a three-step prevention programme to be held during the last two years of primary school, whilst the latter is a programme to be held
during the last two years of preschool. It is understood that educators are not asked to become clinicians, but they might closely collaborate with clinicians by supporting children which are coping with mood disorders.

Clinicians have found that fasting was frequently accompanied by an increased level of vigilance and a mood improvement, a subjective feeling of wellbeing, and sometimes of euphoria.

Objective : (i) to provide a systematic review on the impact of therapeutic fasting on mood (ii) to explore the biological mechanisms activated during fasting that could have an effect on brain function with particular focus on mood (we do not discuss here the mechanisms regulating eating behavior). (iii) to recall the principles of safe medical fasting, it’s indications and contraindications.

Method: We explored Medline (1966-present) and Web of Science (1975-present) according to the PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-Analysis). The research paradigm was: [fasting AND (mental health OR depressive disorders OR mood OR schizophrenia OR psychosis OR anxiety)].

Results. (i) Many clinical observations relate an early (between day 2 and day 7) effect of fasting on depressive symptoms with an increase in mood, alertness and a sense of tranquility reported by patients. (ii) Many neurobiological mechanisms have been proposed to explain this efficiency such as changes in neurotransmitters, quality of sleep, synthesis of neurotrophic factors. (iii) Therapeutic fasting, following an established protocol, is safe and well tolerated.

Conclusion. Fasting therapy could be particularly interesting in depression, resistant or not, in patients with a 25-40 body mass index, or requiring a rapid response to treatment (suicidal crisis, melancholia). Exploratory studies are needed in anxiety disorders, bipolar disorders and psychotic disorders.

Background: The study aimed to elucidate previously observed associations between morningness-eveningness and depressive symptomatology in university students. Relations between components of depressive symptomatology and morningness-eveningness were analysed.
Methods: Nine hundred and seventy-four university students completed Polish versions of the Centre for Epidemiological Studies – Depression scale (CES-D; Polish translation appended to this paper) and the Composite Scale of Morningness. Principal component analysis (PCA) was used to test the structure of depressive symptoms. Pearson and partial correlations (with age and sex controlled), along with regression analyses with morning affect (MA) and circadian preference as predictors, were used.
Results: PCA revealed three components of depressive symptoms: depressed/somatic affect, positive affect, interpersonal relations. Greater MA was related to less depressive symptoms in three components. Morning circadian preference was related to less depressive symptoms in depressed/somatic and positive affects and unrelated to interpersonal relations. Both morningness-eveningness components exhibited stronger links with depressed/somatic and positive affects than with interpersonal relations. Three CES-D components exhibited stronger links with MA than with circadian preference. In regression analyses only MA was statistically significant for positive affect and better interpersonal relations, whereas more depressed/somatic affect was predicted by lower MA and morning circadian preference (relationship reversed compared to correlations).
Limitations: Self-report assessment.
Conclusions: There are three groups of depressive symptoms in Polish university students. Associations of MA with depressed/somatic and positive affects are primarily responsible for the observed links between morningness-eveningness and depressive symptoms in university students. People with evening circadian preference whose MA is not lowered have less depressed/somatic affect.

Background: Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods: We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results: In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = –0.583) with a large effect for psychotic disorders (Hedges g = –0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations: Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion: Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.

This assessment tool identifies contributing factors to presenting problems, identifies goals in counseling, helps form a therapeutic alliance, and deepens client insight into the story behind current difficulties. Simply completing this questionnaire can be a healing experience in itself.

We examined the prevalence rates of mental and neurodevelopmental illness among members of three different fandoms: anime, My Little Pony (brony), and furry. In total, nearly 2,600 fans across these groups self-reported whether or not they had ever been diagnosed with a psychological and/or neurodevelopmental illness. Data revealed that anime fans, bronies, and furries all show higher rates of diagnoses on the autism spectrum than rates observed in studies of the general population. Rates of mood and anxiety disorders were lower than that of the general population. Rates of attention-deficit/hyperactivity disorder were lower in anime and brony fandoms, but were not different from the general population for furry fans. Taken together, the results provide an exploratory look at mental health issues in fan communities and suggest both commonalities across fan groups and idiosyncrasies within particular fandoms.

Objective: Bipolar disorder has been examined extensively in adulthood. An earlier onset, increased symptoms, longer duration and severe presentation of comorbidities were found in adult BD with adversity during childhood.  However, there are no reports of review about the risk of childhood maltreatment in youth with BD. The aim of this review is to examine the association between history of adverse childhood experiences and diagnosis of bipolar disorder in children and adolescents.

Methods: Studies were generated electronically. From title, abstract and full paper, studies were screened using the inclusion/exclusion criteria and synthesised findings of individual studies regarding the association.

Result: Eight studies were included in this review and revealed that no direct association can be firmly concluded between diagnosis of BD in children and adolescents and ACE. History of ACE in BD youth contributed to an earlier onset, however, does not predict onset of BD. Physical, sexual abuse and SUD were related to severe presentation of BD symptoms and longer duration of BD, development of CD lifetime prevalence of PTSD and suicidal attempts. However, ADHD did not show difference with non-BD or non-ACE BD youth.

Conclusion: Across studies, direct association between BD diagnosis and adverse experiences cannot be established. Therefore, association remain uncertain. Nonetheless, adverse experiences of BD youth influence the presentation of clinical variables (symptoms severity, duration of illness, CD, PTSD, and suicidality) in the manifestation of BD.

Limitation: Outcomes were fluctuating throughout studies and onset of diagnosis was not significantly indicated due to lack of studies. Additionally, some studies did not mention the measurement of ACE. Finally, types and degree of adversity differs in BD participants amongst included studies.

The manic phase of Bipolar I Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD).

Narcissists mourn the loss of narcissistic supply; they grieve over vanished sources of supply; they bemoan the injustice and discrimination that they suffer at the hands of their inferiors. Narcissists are often in a bad mood, anhedonic, dysphoric, and outright depressed. The narcissist’s mood swings are self-destructive and self-defeating.

This is a suicide note contains a real-life story of battling with severe mental illnesses. The author is a lecturer, a researcher, a mental health advocate, an author of several books in philosophy and psychology, and has an educational YouTube channel.

BACKGROUND: Bipolar disorder (BD) may be associated with significant and persistent cognitive impairment. The aim of this study was to describe the profile of cognitive deficits in BD at different phases of the illness and determine whether it is different from that of schizophrenia and unipolar (UP) depression.

METHODS: A systematic review of the computerised literature of neuropsychological studies of BD published between 1980 and 2000.

RESULTS: General intellectual function: this was largely preserved in BD. Impairments when present were limited to acute episodes and to performance scores. Attention: attentional abnormalities were seen in symptomatic BD patients and persisted in remission in measures of sustained attention and inhibitory control. Memory: verbal memory was impaired even in euthymic patients while visuo-spatial memory deficits were variable depending on the tasks used. Executive function: all aspects of executive function (planning, abstract concept formation, set shifting) were impaired in symptomatic BD patients. Performance on executive function tests was sensitive to the presence of even residual symptoms but it may be normal in fully recovered patients with uncomplicated BD. Comparison to other patient groups: no major differences in cognitive profile between BD and UP depression were found. Remitted BD patients out-performed stable schizophrenics on most cognitive measures but this advantage disappeared when they were acutely symptomatic.

CONCLUSIONS: Symptomatic BD patients have widespread cognitive abnormalities. Trait related deficits appear to be present in verbal memory and sustained attention. Executive function and visual memory may be also affected at least in some recovered BD patients

Resumen
Los desórdenes emocionales (DE), que incluyen trastornos de ansiedad, del estado de ánimo y adaptativos, comparten con las somatizaciones una fuerte asociación con factores psicosociales, como el estrés, altos niveles de ansiedad o emocionalidad negativa, y son muy frecuentes en Atención Primaria (AP). La hiperfrecuentación de estos pacientes, el bajo grado de adecuación del tratamiento convencional a la evidencia científica y su baja eficacia han llevado a la puesta en marcha de programas de intervención psicológica de tipo cognitivo-conductual en AP, que mejoran la eficacia, la eficiencia, y están recomendados por guías clínicas de alta calidad. En el presente artículo se propone un enfoque de los DE y somatizaciones basado en problemas de regulación emocional (elevados sesgos cognitivos y aprendizaje emocional desadaptado), que defiende la posibilidad de hacer reversibles estos procesos cognitivo-emocionales que han llevado al desorden, usando técnicas cognitivo-conductuales,

Palabras clave: Emociones, Trastornos de ansiedad, Trastornos del estado de ánimo, Atención Primaria, Técnicas Cognitivo-Conductuales, Práctica basada en la evidencia científica.

Theoretical and empirically supported psychological interventions for emotional disorders in primary care: An update.

Abstract
Emotional disorders (ED), including anxiety, mood and adaptive disorders, and somatization share common pathways with psychosocial factors, such as stress, high levels of anxiety or negative emotionality, and are very common in primary care (PC). The frequency of PC visits made by these patients and the low efficacy of non-established evidence-based usual treatments have promoted the implementation of psychological intervention programmes of a cognitive-behavioural type to help improve the effectiveness and efficiency rates, following the recommendations of high-quality clinical guidelines. This paper proposes an integrative approach for ED and somatization based on emotional regulation problems (elevated cognitive biases and unadaptive emotional learning) that defends the possibility of reversing the cognitive-emotional processes involved in the onset of these disorders, using cognitive-behavioural techniques, especially cognitive restructuring and exposure. In addition, we analyse and discuss the theoretical foundations of these techniques (which can act as the psychological support of collaborative programmes), according to the principles of proper emotion regulation (cognitive bias reduction and adaptive emotional learning). Finally, the dissemination of these effective psychological treatments is recommended, with a transdiagnostic focus and Internet-based homework, through the implementation of collaborative stepped programmes in PC.

Key Words: Emotions, Anxiety disorders, Mood disorders, Primary Care, Cognitive-behavioural techniques, Evidence-based practice.

Mood disorder merupakan hal yang umum dan lazim (gangguan ini terbanyak ditemukan baik dipelayanan kesehatan mental maupun dalam praktek dokter medis umum). Berdasarkan hasil penelitian yang dilakukan di Amerika Serikat dan Eropa, diperkirakan 9-26%  wanita dan 5-21% pria pernah mengalami depresi yang gawat di dalam kehidupan mereka.
Hampir 2/3 individu yang mengalami depresi memikirkan untuk bunuh diri dan hanya 10-15% yang melakukan percobaan bunuh diri. Mereka yang di bawa ke rumah sakit karena percobaan bunuh diri akan lebih berhasil bunuh diri daripada mereka yang belum dirawat di rumah sakit. Hampir semua pasien (97%) mengeluh bahwa mereka kekurangan energi, sukar menyelesaikan tugas mereka, prestasi belajar menurun, prestasi pekerjaan menurun, kurang motivasi untuk menerima tugas atau proyek baru.

It is a time to recognize a range of issues—about  mental health illnesses —and the effects they have not only on the people personally experiencing and struggling with them, but on society at large. But what does it mean to be aware of mental health, exactly, and how does that awareness to our mental health matters?

Narcissistic Personality Disorder (NPD) is often co-diagnosed with or misdiagnosed as Schizoid and Paranoid Personality Disorders; Histrionic Personality Disorder) and Somatic Narcissism; Depression; Dissociative Identity Disorder; Attention Deficit Hyperactivity Disorder; Bipolar Disorder; Asperger's Disorder; Generalized Anxiety Disorder; Borderline Personality Disorder; Schizotypal Personality Disorder; Psychosis; Antisocial Personality Disorder (Psychopathy); Neuroses; Masochism; Sexual Perversions; Munchausen and Munchausen by Proxy Syndromes (Factitious Disorders).

BACKGROUND: Distress, anxiety and depression are common emotional complications of cancer that deserve clinicians attention, as well as, the ways patients choose to cope with this difficult moment and the implications associated with disease and treatment in their quality of life (QoL). We examined the correlation between symptoms of distress, anxiety and depression, coping and quality of life among cancer patients from a Brazilian Cancer Center. METHOD: 44 patients participated in this pilot study, 27.3% were male and 72.7% female, average age was 57 (SD513.8), most of patients were married (70.5%), and 45.5% had college degree. The Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-General and the Ways of Coping Checklist were used to evaluate the psychosocial aspects, followed by a multidisciplinary discussion to define the best intervention for each case. This research was authorized by the ethics committee and the data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: In the beginning of treatment, 40.9% of patients had a clinically significant level of distress, 29.5% had anxiety and 25% depression, the average QoL was 89.3. At the midcycle assessment, 14% presented with distress, 4% anxiety and depression, the average QoL was 94.1. On the last day of chemotherapy 7.1% still scored above 4 on the DT, 4% showed anxiety and depression, and the average QoL was 98.7. The most common forms of coping used in all stages of evaluation was seeking social support; the second one was planful problem-solving in the beginning and distancing at middle and last day. CONCLUSIONS: This study shows that patients with high distress have worse QoL (74.8% with QoL o85) than patients without it (30% with QoL o85). Considering that coping is a major factor in the relation between distress (depression and anxiety) and cancer adaptation, patients tend to emotional support (seeking for social support) and to make efforts to seek informational. The progressive decrease of distress, anxiety and depression was attributed to screening and monitoring routine for identifying the level and nature of distress as well as the multidisciplinary intervention tailored to each case. RESEARCH IMPLICATIONS: This result supports the importance of these analyses, and the multidisciplinary discussion as a method of understanding the relations between distress, mood disorder, coping and QoL, as well as of understanding coping process and the mechanisms through which they come to affect patient’s well-being over the treatment. Furthermore, it is important to identify intersection points between patient’s psychological adjustment to cancer to know more about our patients and to offer a quality cancer care. CLINICAL IMPLICATIONS: In this journey patients have to appraisal and reappraisal to revise the meaning of events in ways that were more consistent with their new situation in an attempt to find a tolerable meaning to the event. It is important to know how is this patients process to propose the appropriate intervention strategies. Such knowledge, can favor the adequate assistance to patients because of the understanding of suffering and doubts present in the phases of disease. ACKNOWLEDGEMENT OF FUNDING: None.

This literature review covers research evidence showing the benefits of nature connection for depressive symptoms in Section I, and explores which techniques and interventions have been developed by the field especially as it incorporates mindfulness and somatic modalities in Section II. It seeks to answer the research questions: is Ecotherapy an evidence-based practice with research demonstrating what mechanisms of human psychology it might be operating by to produce beneficial effects? Can Ecotherapy alleviate symptoms of clinical depression? Are there specific modalities, techniques, and interventions developed by the field to implement the research findings in an applied, clinical setting? The gap in the literature this author focuses on is how to integrate nature connection with modalities of Hakomi mindfulness-based somatic psychotherapy, psychodrama experiential drama therapy group work, and Wilderness Rites of Passage.

Keywords: Ecotherapy, ecopsychology, nature-assisted therapy, more-than-human-community, nature connection, connectedness to nature, connectivity with nature, time in nature, green care, green exercise, emotional affinity toward nature, nature relatedness, ecological self, Gaia hypothesis, biophilia, depression, depressive disorders, affective disorders, mood disorders, Major Depressive Disorder, mindfulness, interdependence, interbeing, interpenetration, embedment, somatic, body therapy, embodiment, ecosomatic, experiential therapy, role play, psychodrama, action methods, walk and talk, Hakomi, Focusing, Dance Movement Therapy, Shinrin-Yoku, forest bathing, wilderness rites of passage, rites of passage

Background: In patients with epilepsy polycystic ovary (PCO) syndrome has been reported to be associated with the use of the anticonvulsant sodium valproate. Whether PCO syndrome is associated with valproate use in patients with bipolar disorder is not adequately explored.
Method: 76 female outpatients with a DSM-IV diagnosis of bipolar disorder between the ages of 18 and 45 years and who were taking monotherpy with valproate 38, lithium 18, oxcarbazepine 14 and lamotrigine 6 were evaluated. Patients completed questionnaires about their medical, psychiatric, and reproductive health histories and body mass indices were calculated. In the early follicular phase of their menstrual cycle, women were examined for hirsutism, given a transvaginal ultrasound, and assessed serum levels of testosterone, estradiol, luteinising hormone and follicle-stimulating hormone.
Results: 50% of females receiving valproate exhibited menstrual irregularities and polycystic ovaries. Only 7.9% receiving valproate had features of PCOS. Out of 4 cases of PCOS three were (75%) in the valproate group and one was in oxcarbazepine/lamotrigine group. Serum testosterone level was also high in vaproate group. Commonest menstrual problem in the valproate group was irregular menstrual cycle (34.2%) followed by amenorrhea (23.7%) and oligomenorrhea (21%). 45% patients receiving oxcarbazepine/ lamotrigine exhibited irregular menstrual cycle, 20% oligomenorrhea and 15% amenorrhea. Lithium group had lesser frequency of these symptoms. Comparison of individual menstrual problems showed menorhagia higher in the valproate group. In the valproate group 3 patients had menstrual abnormalities before initiation of medication for bipolar disorder. Serum testosterone level was significantly higher and FSH was lower in the valproate group.
Conclusion: In this study of bipolar patients, PCO-like changes were common in women receiving valproate though there was no significant difference compared to other mood stabilizers. Independent of the therapeutic agent used, the bipolar women in this study reported high rates of menstrual disturbances, hormonal disturbances and PCOD suggesting that the hypothalamic-pituitary-gonadal axis may be compromised in some women with bipolar disorder.

Extensive research studies showed the existing interaction between different systems of the body that maintain the stability of homeostatic processes and which allow species to adapt to its environment in response to stressors. Adaptive responses to stressors activates adaptive-mechanisms, that result in the synthesis and release of several brain neurotransmitters, peptide hormones, proinflammatory cytokines and adrenal steroids from neural, neuroendocrine and immune cells which prepared the organism to alert its systems to adopt the proper behavioral responses against stressful events. Neurotransmitters, peptide hormones and cytokines act through the HPA axis forming a regulatory loop that maintains homeostasis in response to different stressors. One route to understand the interactions between brain transmitters, neurosecretory peptide-hormones, adrenal steroids and immune-borne cytokines, including neurotrophic factors is when body`s systems and chemical communication between cells appear to be disrupted during stressful events as occurs in mood-related disorders and depression. Thus, this review will described the functional interactions between HPA axis activity and the projecting neural pathways (DRN-5HT neurons; LC-NA neurons) and brain neurotransmitters (NE, 5-HT, DA, GLU) that impinge on forebrain-limbic structures (hypothalamus, hippocampus, mPFCx) that drive the release of the CRH and CRH-dependent secretion of ACTH from anterior hypophysis and cortisol from adrenal glands, under stressful conditions. Moreover, interactions between immune-borne cytokines and HPA axis activity, and glucocorticoid receptors have been shown to be extremely important to understand the pathophysiological mechanisms that operate in mood-related disorders and MDD, including the stress-inducing altered changes in brain morphology, neuronal atrophy and neurogenesis in brain areas involved in learning processing and memory functions.

Purpose: This article focuses on recent evidence linking Rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes, the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects.

Methods: PubMed and Google Scholar records were examined for articles utilizing predefined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.

Results: REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.

Conclusion: Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps foundational ways in which the phe-nomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of inten-tionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces. Keywords schizophrenia – mood disorder – mania – melancholia – depression – interpersonal phenomenology – phenomenological psychopathology

Il semble que près de 35 % de la population adulte signale des troubles de sommeil durant l’année et que 10 % de la population générale souffrirait d’insomnie chronique. Les conséquences de l’insomnie sont nombreuses et néfastes pour le patient. En effet, 40 % des gens souffrant d’insomnie non traitée risquent de souffrir d’une dépression majeure durant l’année qui suit. De plus, dans de 35 % à 40 % des cas, l’insomnie est associée à un trouble de l’humeur, à de l’anxiété ou à un problème de dépendance ou d’alcoolisme.

As emotion is a dynamic construct, ecological momentary assessment (EMA) methods, which gather data at multiple time points in individuals' real-world environments, in the moment, are particularly well suited to measure emotion dysregulation and related constructs. EMA methods can identify contextual events that prompt or follow an emotional response. This chapter provides an overview of traditional methods of studying emotion dysregulation and how EMA can be used to capture emotion dysregulation in daily life, both within and independent of psychiatric diagnoses. It reviews the literature on emotion dysregulation and related constructs within specific diagnoses (e.g., depression, bipolar disorder, borderline personality disorder, and eating disorders) and behaviors (e.g., suicide, nonsuicidal self-injury, and alcohol use). Finally, it discusses future directions in EMA research, as well as its implications for psychological treatment.

Here is Chapter 2 of my book Experiences of Depression: a Study in Phenomenology (OUP, 2015). This chapter includes my most detailed account to date of 'existential feeling', which the remaining chapters put to work in order to interpret experiences of depression.

***Oxford University Press has repeatedly bumped up the price of this book, and it is now far too expensive. If you would like a copy, please email me (matthew.ratcliffe@york.ac.uk) and I'll send you a PDF instead.***

Objectives: To evaluate the neurobiological, psychophysical and behavioural measures of affective instability in clinical populations.

Data sources: A range of medical and psychological science electronic databases were searched (including MEDLINE, EMBASE, and PsycINFO). Hand searching and reference checking are also included.

Review methods: Reviews, systematic reviews, experimental and cross-sectional studies, providing affective instability in neurobiological and behavioural measurements in clinical populations. Studies were selected, data was extracted and quality was appraised.

Results: Twenty-nine studies were included, 6 of which were review studies (one a meta-analysis) and 23 of which were primary studies, across a wide variety of disorders including ADHD, bipolar affective disorder, schizophrenia, severe mood dysregulation, major depression, and borderline personality disorder.

Conclusions:  The bulk of the studies converge on the role of the amygdala, particularly in borderline personality disorders, and how it connects with other areas of the brain.  Future research needs to extend these findings across diagnoses and development.

En este trabajo exploramos la narrativa, operativizada como constructos
personales, de personas con distimia. Primero se examina, mediante el sistema de
categorías de constructos personales, el contenido general del sistema de construcción
de los distímicos (n = 53) y se compara con una muestra no clínica (n = 53). A
continuación, se analizan las dimensiones de significado más relevantes de la muestra
clínica en comparación al grupo control. Finalmente, analizamos la presencia y el
contenido de los dilemas implicativos identificados con la técnica de la rejilla de Kelly.
Los resultados indican que las personas con distimia utilizan significativamente más
constructos de tipo emocional, y menos de tipo intelectual. Las dimensiones de
significado “fuerte-débil” y “tolerante-autoritaria” resultan de especial relevancia en la
narrativa de los distímicos. Por otro lado, el contenido de los constructos congruentes de
los dilemas implicativos, que reflejan aspectos relacionados con la identidad y los
valores, pertenecen en su mayoría al ámbito de la moralidad y la calidez emocional.
Mientras que los constructos discrepantes presentan contenido vinculado al ámbito de la
afectividad y especialmente a la dimensión de significado “fuerte-débil”. Se dibuja un
mapa de la narrativa en la distimia y se relaciona con los modelos explicativos
existentes. Se concluye el trabajo proponiendo nuevas aproximaciones de investigación.

"Patient care has traditionally been guided by the conventional paradigm known as the medical or biomedical model, whose roots can be traced back to the era of reductionism and mind-body dualism, which separates the mental from the somatic. (Engel, 1977) In this model, disease is defined as a biophysical malfunction. (Engel, 1977) In the biomedical model, the goal of treatment is to correct the malfunction in order to cure the disease. (Engel, 1977) As such, this traditional medical model places the pathophysiology of the disease, objective tests, and therapeutic interventions at the centre of patient care. (McCollum, 2009) Such a model offers a one-dimensional approach to patient care that excludes the patient experience of illness and how this might impact other facets of the patient’s life (e.g., work disability, finances, social networks, etc.) because they are believed to lie outside of medicine’s responsibility and authority. (McCollum, 2009; Engel, 1977)

By incorporating other psychological (e.g., thoughts, emotions, behaviors) and social dimensions of the patient into the care plan, one moves towards the bio-psycho-social (BPS) model of patient care. (Phelps, 2009) The BPS model was first theorized by a psychiatrist, Dr. George L. Engel, in 1977. (Engel, 1977) In the BPS model, patient care is based on the belief that psychological and social dimensions also contribute significantly to human functioning within the context of disease or illness and, as such, need to be considered when providing care to a patient. (Engel, 1977) Specifically, the biological component examines the cause of the illness and how it affects the functioning of the body. (Engel, 1977) The psychological component of the model explores any potential psychological causes for the illness (e.g., lack of self-control, emotional stressors, negative-thinking, etc.). (Engel, 1977) Finally, the social component considers how different social factors (e.g., socioeconomic status, religion, culture, etc.) impact illness. (Engel, 1977) In order to address all aspects of this three-dimensional model, an integrated team approach involving allied healthcare professionals such as physicians, nurses, psychologists, pharmacists, social workers, and rehabilitation specialists are critical for ensuring that more comprehensive patient care is provided. (Phelps, 2009) Overall, the underlying premise of the BPS model is that the body and mind are intricately connected and what affects one will affect the other. (Halligan, 2006; Freudenreich, 2010) However, while this model advances patient care and can address the dis-ease that exists within the disease, it still does not encompass the patient as a “whole” and consider all the multitude of facets that make up the individual.

An alternative model to the biomedical and BPS model of care is the recovery model. In the recovery model, the patient is involved in a lifelong recovery process that involves a number of incremental steps across various facets of his or her life. (Turton, 2010) Moreover, the primary illness is seen as only one dimension in the patient’s recovery process. (Turton, 2010) Other key aspects of this model include negotiating treatment approaches between patients and practitioners such that the patient feels empowered. (Turton, 2010) Moreover, this model enables patients to regain their dignity and identity beyond the illness. (Turton, 2010) As such, this model takes the BPS model and advances it forward to include other patient dimensions in the provision of their care. Thus, the underlying ethos of this model for the patient is one of hope and optimism. (Turton, 2010)

A recent study conducted in ten European countries aimed to examine the recovery model of patient care in order to identify aspects of care that key stakeholders believed to be most important in the promoting recovery, specifically in patients with mental illness. (Turton, 2010) Eleven important domains of care identified by stakeholders in this study included: (1) social policy and human rights, (2) social inclusion, (3) self-management and autonomy, (4) therapeutic interventions, (5) governance, (6) staffing, (7) staff attitudes, (8) institutional environment, (9) post-discharge care, (10) caregivers, and (11) physical health care. (Turton, 2010) The authors also found that there was generally a high consensus between groups and countries with some modest differences in priorities noted. (Turton, 2010) Interesting, the most highly rated aspect of care was therapeutic interventions, a central piece of the more traditional medical model of care. (Turton, 2010) The authors suggest that stakeholders may still hold therapeutic interventions as the most important aspect of care because such interventions form the foundation and ‘raison d’être’ of health care. (Turton, 2010) Thus, it may be difficult for practitioners to step away from convention and embrace a new paradigm.

Incorporating various aspects of the BPS and recovery model of patient care, a patient-centered care (PCC) model has evolved over the last several years to replace the conventional biomedical model of care. (Laird-Fick, 2010) The Institute of Medicine (IOM) has stated that embracing a PCC model will help to close the “quality chasm” often present in the care provided to patients. (IOM, 2001) In a PCC model, the patient’s individuality is central. (Wolf, 2008) The patient has the right to have his or her needs, desires, beliefs, values, and goals respected and placed at the centre of the care plan. (Laird-Fick, 2010; Wolf, 2008) Such respect of the patient’s individuality is part of the team’s commitment to understand the patient’s perspective of his or her own health status and subsequent care. (Wolf, 2008) The underlying ethos of this model of care is that the patient has the right to respect, dignity, and care that focuses on the person and situation versus the disease process. (Wolf, 2008)

Our hypothesis is that the medical and bio-psycho-social models act as an essential foundation on which a more patient functionality centered model evolves: the Collaborative Patient/Person-Centric Care Model (CPCCM). This has a paradigm shift in the deliverables of patient care which involves talking to patients and family, listening to their desired outcomes, collaborating with allied health team members in order to help facilitate these patient goals, and finally formulating an individualized care plan that combines the patient’s wishes with the clinical endpoints derived from a uniform therapeutic thought process. The root of this theory is enmeshed in goal driven outcomes, as are the other models. However the goal is driven by the patient and then filtered through the professional lenses of the members of the treating team versus the converse. This evidence-informed versus evidence-based approach is more patient centric than when outcomes are determined independently by clinicians in a traditional hierarchical structure. This also allows the current structure to be realigned along a linear axis. (Lamoure 2008)" Joel Lamoure, Jessica Stovel, Matthew Piamonte et al.

E. Laurent & P. Vandel (Eds.)

Que ce soit dans la vie professionnelle ou dans la vie privée, les concepts employés pour décrire les états affectifs sont multiples : humeur, émotion, burnout, dépression, bipolarité.

Les auteurs du présent ouvrage distinguent ces concepts et abordent les aspects théoriques et pratiques de l’humeur normale et de l’humeur pathologique. Ils présentent à la fois les déterminants de l’humeur (exercice physique, personnalité, sommeil, trauma…) et ses conséquences (addictions, motivation et effort, mouvements oculaires, perception du temps, sélection de l’information, risque suicidaire…). Ils font également le point sur les nombreuses méthodes qui permettent d’évaluer l’humeur et de prendre en charge ses pathologies : analyses des concentrations hormonales et de l’activité cardiaque, imagerie et stimulations cérébrales, pharmacologie, psychothérapie, tests neuropsychologiques ou olfactifs, vidéo-oculographie…

Le caractère interdisciplinaire de l’ouvrage est associé à une multiplicité de niveaux d’analyse (cérébral, comportemental, expérientiel, moléculaire) qui constituent autant de perspectives de compréhension et de transformation de ce processus complexe.

www.deboecksuperieur.com
ISBN 978-2-35327-354-6

Éric Laurent est Maître de Conférences en psychologie cognitive à l’université de Franche-Comté, Directeur-adjoint du Laboratoire de psychologie (EA 3188) de l’université Bourgogne Franche-Comté et Responsable de l’Action de recherche « Oculomotricité, Cognition et processus
Thymiques (OCT) » à la Maison des Sciences de l’Homme et de l’Environnement « Claude-Nicolas Ledoux », CNRS & Université Bourgogne Franche-Comté.

Pierre Vandel est Professeur de psychiatrie à l’université de Franche-Comté, Chef de service de psychiatrie de l’adulte et Coordinateur du Centre Mémoire de Ressources et de Recherche de Franche-Comté au Centre hospitalier régional universitaire de Besançon. Il est chercheur au Laboratoire de Neurosciences (EA 481) de l’université Bourgogne Franche-Comté.

Diagnostic criteria for mood disorders including major depressive disorder (MDD) largely ignore biological factors in favor of behavioral symptoms. Compounding this paucity of psychiatric biomarkers is a need for therapeutics to adequately treat the 30-50% of MDD patients who are unresponsive to traditional antidepressant medications. Interestingly, MDD is highly prevalent in patients suffering from chronic inflammatory conditions, and MDD patients exhibit higher levels of circulating pro-inflammatory cytokines. Together, these clinical findings suggest a role for the immune system in vulnerability to stress-related psychiatric illness. A growing body of literature also implicates the immune system in stress resilience and coping. In this review, we discuss the mechanisms by which peripheral and central immune cells act on the brain to affect stress-related neurobiological and neuroendocrine responses. We specifically focus on the roles of pro-inflammatory cytokine signaling, peripheral monocyte infiltration, microglial activation and hypothalamic-pituitary-adrenal (HPA) axis hyperactivity in stress vulnerability. We also highlight recent evidence suggesting that adaptive immune responses and treatment with immune modulators (exogenous glucocorticoids, humanized antibodies against cytokines) may decrease depressive symptoms and thus represent an attractive alternative to current antidepressant treatments.