Debra A. Scrandis

Toxoplasma gondii Antibody Titers and History of Suicide Attempts in Patients With Recurrent Mood Disorders

Toxoplasma gondii (T.gondii) is an obligate intracellular protozoan parasite infecting one-third of the world population, residing relatively silently in the brain of the immunocompetent host. We hypothesized that T.gondii seropositivity and serointensity are associated with having a history of attempting suicide and, in those attempting suicide, a greater number of attempts. T.gondii seropositivity and antibody titers were compared between (a) patients with recurrent mood disorders with history of suicide attempt (99 individuals) versus (b) patients with recurrent mood disorders without history of suicide attempt (119 individuals), and (c) healthy controls (39 individuals). Diagnosis was made using the Structured Clinical Interview for DSM-IV. Statistical methods included chi square, analysis of variance, and linear and logistic regression analyses. Suicide attempters had higher T.gondii antibody titers than nonsuicide attempters (p = 0.004). The logistic regression analysis revealed a predictive association between titers of anti- T.gondii antibodies and history of suicide attempt with OR = 1.55 (1.14–2.12), p = 0.006. No significant relationship was found between T.gondii seropositivity and suicide attempt status, number of prior suicide attempts, and recurrent mood disorder diagnosis. Although preliminary and bearing replication, this is the first report, to our knowledge, of an association between attempting suicide and T. gondii.

Normalizing Postpartum Depressive Symptoms With Social Support

BACKGROUND: Postpartum depression can be a significant disability for women if left untreated. The context of seeking social support for this population has not been examined. OBJECTIVE: The purpose of this study was to generate a theory of how women experiencing postpartum depressive symptoms mobilize social supports. STUDY DESIGN: Strauss and Corbin’s grounded theory methodology was used to discover the context and process of seeking social support of women with postpartum depression. RESULTS: Postpartum women with depressive symptoms have a natural desire to connect with others for symptom normalization. These connections occurred with other women, groups, or health care providers. The process of normalizing through connection included four components: initiating socialization, staying with, drifting away, and incorporating self into new role. CONCLUSIONS: Nurses can assist postpartum women in developing positive connections with other individuals or groups in their lives. Psychoeducation about postpartum depression may empower women to seek assistance for their depression.

Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts.

Abstract Background Anecdotal reports of mood disorder following infection with common respiratory viruses with neurotropic potential have been in existence since the last century. Nevertheless, systematic studies on the association between these viruses and mood disorders are lacking. Methods Influenza A, B and coronavirus antibody titers were measured in 257 subjects with recurrent unipolar and bipolar disorder and healthy controls, by SCID. Pearsons χ² tests and logistic regression models were used to analyze associations between seropositivity for coronaviruses, influenza A and B viruses and the following: a) history of recurrent mood disorders b) having attempted suicide in the past c) uni- vs. bi-polarity and d) presence of psychotic symptoms during mood episodes. Results Seropositivity for influenza A (p =0.004), B (p <0.0001) and coronaviruses (p <0.0001) were associated with history of mood disorders but not with the specific diagnosis of unipolar or bipolar depression. Seropositivity for influenza B was significantly associated with a history of suicide attempt (p =0.001) and history of psychotic symptoms (p =0.005). Limitations The design was cross-sectional. Socioeconomic factors, inflammatory markers, and axis II psychopathology were not assessed. Conclusions The association of seropositivity for influenza and coronaviruses with a history of mood disorders, and influenza B with suicidal behavior require replication in larger longitudinal samples. The need for these studies is additionally supported by the high incidence of these viral infections, the high prevalence of mood disorders, and resilience of suicide epidemics.

Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season

Manalai P, Hamilton RG, Langenberg P, Kosisky SE, Lapidus M, Sleemi A, Scrandis D, Cabassa JA, Rogers CA, Regenold WT, Dickerson F, Vittone BJ, Guzman A, Balis T, Tonelli LH, Postolache TT. Pollen‐specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season. Bipolar Disord 2012: 14: 90–98.

Depression after Delivery: Risk Factors, Diagnostic and Therapeutic Considerations

Postpartum mood disorders can negatively affect women, their offspring, and their families when left untreated. The identification and treatment of postpartum depression remains problematic since health care providers may often not differentiate postpartum blues from depression onset. Recent studies found potentially new risk factors, etiologies, and treatments; thus, possibly improving the untreated postpartum depression rates. This integrated review examined several postpartum psychiatric disorders, postpartum blues, generalized anxiety, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis for current findings on prevalence, etiologies, risk factors, and postpartum depression treatments.

Light treatment for seasonal Winter depression in African-American vs Caucasian outpatients.

AIM To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder. METHODS Seventy-eight study participants, age range 18-64 (51 African-Americans and 27 Caucasians) recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV, were enrolled in an open label study of daily bright light treatment. The trial lasted 6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar II disorder and the remainder had Major depressive disorder. Outcome measures were remission (score ≤ 8) and response (50% reduction) in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-SAD) as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-II. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions. RESULTS The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement. While symptomatic improvement and rate of treatment response were not different between the two groups, African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate (African-Americans 46.3%; Caucasians 75%; P = 0.02). CONCLUSION This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement. In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.

Mindfulness Based Programs Implemented with At-Risk Adolescents

Objective: This review examines studies on mindfulness based programs used with adolescents at-risk for poor future outcomes such as not graduating from high school and living in poverty. Method: The keywords used include mindfulness, at-risk and adolescents in each database to search CINAHL (10 items: 2 book reviews, 3 Dissertations, and 5 research articles), Medline EBSCO (15 research articles), and PubMed (10 research articles). Only primary research articles published between 2009- 2015 in English on mindfulness and at-risk adolescents were included for the most current evidence. Results: Few studies (n= 11) were found that investigate mindfulness in at-risk adolescents. These studies used various mindfulness programs (n = 7) making it difficult to generalize findings for practice. Only three studies were randomized control trials focusing mostly on male students with low socioeconomic status and existing mental health diagnoses. Conclusion: There is a relationship between health behaviors and academic achievement. Future research studies on mindfulness based interventions need to expand to its effects on academic achievement in those youth at-risk to decrease problematic behaviors and improve their ability to be successful adults.

Innovations in Mental Health Care

The traditional means of providing mental health care (e.g. delivered in psychiatric facilities in face to face format) are not meeting many patient needs. The World Health Organization’s (WHO) Mental Health Action Plan [1] lists two key objectives for improving mental health care: integrating mental health care into community settings and strengthening information technology. Patients are more likely to see their primary care providers for their psychiatric symptoms, leave psychiatric care due to fear of stigma [2] and may prefer alternative treatment options for their mental illness. As an Advanced Practice Nurse in Psychiatry, I see patients for medication management who sometimes leave treatment for these same reasons. My practice does not have integrated primary and mental health care AND we do not conduct video or telephone appointment with patients. These deficiencies ultimately affect patients’ mental health. The increased use of technology by patients needs to drive all health care delivery systems to develop innovative methods for improving individuals’ access to mental health care and overall social functioning. I am happy to share some new ideas for mental health care delivery in this special issue. This thematic issue includes review and research articles addressing the two WHO mental health care objectives. Three articles describe primary care providers as avenues to improve access to mental health. Patients’ access to mental health services can be problematic due to limited providers. Kverno describes a new education program to increase the number of mental health nurse practitioners in rural environments by targeting primary care nurse practitioners living in these environments and training them to be psychiatric mental health nurse practitioners. McIntosh, Startsman and Perraud reviews the issue of integrated mental health care (combining mental health and somatic medicine) and its implications for a new role in nursing practice. Kriebel-Gasparro discusses how advanced practice nurses can play a significant role in bipolar disorder screening in primary care. The other three articles examine potential interventions to engage and prevent mental illness sequelae: phone technology (Duarte & Thomas), humor use for substance abuse treatment (Canha) and evidence based mindfulness based interventions for at risk adolescents (Rawlett & Scrandis). These articles can lead nurses in clinical practice and research to expand their thinking to improve mental health care and access using ideas different from the historical care delivery system. It is my hope this issue will open a dialogue to address the pressing mental health needs of our global community.

Leading Organizational Cultural Competency: Nurse Leader Rounds and Care for Diverse Patients.

Chief nurse executives (CNEs) face challenges in providing high-quality, patient-centered care for diverse populations. Although the implementation of culturally and linguistically appropriate services (CLAS) may improve patient satisfaction, the cost of initiatives and education coupled with shortened episodes of care pose obstacles. The article describes themes from a qualitative study with CNEs, describes resources and best practices, and highlights nurse leader rounds as a vehicle for implementing CLAS.