Ismail Cuneyt Guzey

Gender and offender status predicting treatment success in refugees and asylum seekers with PTSD

Background Current knowledge is limited regarding patient characteristics related to treatment outcome of posttraumatic stress disorders (PTSD) in refugees and asylum seekers. Objective Gender, torture status, offender status, level of anger, and level of depression were investigated for possible effects on the treatment outcome. Method Patient characteristics were explored in 54 refugees and asylum seekers who had completed a treatment program for PTSD. Non-responders (10), those who had the same or higher levels of symptom severity after treatment, were compared with responders, those who had lower symptom severity after treatment (44). Symptom severity was measured by Clinician-Administered PTSD Scale. The non-responders and responders constituted the dichotomous, dependent variable. The independent variables were gender, torture status, offender status, level of anger, and level of depression. T-tests and Exact Unconditional Homogeneity/Independence Tests for 2X2 Tables were used to study the relationship to treatment outcome. Results Being male and reporting to have been a violent offender were significantly more frequent characteristics among the non-responders compared to the responders. The levels of pretreatment anger, depression and torture status did not affect the treatment outcome. Conclusions The study adds support to findings that females benefit more from treatment of PTSD than males and that violent offenders are difficult to treat within the standard treatment programs.

Child exposure to serious life events, COMT, and aggression: Testing differential susceptibility theory.

Both genetic and environmental factors contribute to individual differences in aggression. Catechol-O-methyltransferase Val158Met (COMT), a common, functional polymorphism, has been implicated in aggression and aggression traits, as have childhood experiences of adversity. It is unknown whether these effects are additive or interactional and, in the case of interaction, whether they conform to a diathesis-stress or differential susceptibility model. We examined Gene × Environment interactions between COMT and serious life events on measures of childhood aggression and contrasted these 2 models. The sample was composed of community children (N = 704); 355 were boys, and the mean age was 54.8 months (SD = 3.0). The children were genotyped for COMT rs4680 and assessed for serious life events and by teacher-rated aggression. Regression analysis showed no main effects of COMT and serious life events on aggression. However, a significant interactive effect of childhood serious life events and COMT genotype was observed: Children who had faced many serious life events and were Val homozygotes exhibited more aggression (p = .02) than did their Met-carrying counterparts. Notably, in the absence of serious life events, Val homozygotes displayed significantly lower aggression scores than did Met carriers (p = .03). When tested, this constellation of findings conformed to the differential susceptibility hypothesis: In this case, Val homozygotes are more malleable to the effect of serious life events on aggression and not simply more vulnerable to the negative effect of having experienced many serious life events.

Polygenic risk, appetite traits, and weight gain in middle childhood:A longitudinal study

IMPORTANCE Genome-wide association studies have identified genetic risks for obesity. These genetic risks influence development of obesity partly by accelerating weight gain in childhood. Research is needed to identify mechanisms to inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Longitudinal studies are needed to test whether appetite traits mediate genetic influences on childrens weight gain. OBJECTIVE To test whether genetic risk for obesity predicts accelerated weight gain in middle childhood (ages 4-8 years) and whether genetic association with accelerated weight gain is mediated by appetite traits. DESIGN, SETTING, AND PARTICIPANTS Longitudinal study of a representative birth cohort at the Trondheim Early Secure Study, Trondheim, Norway, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Participants were sampled from all children born in 2003 or 2004 who attended regular community health checkups for 4-year-olds (97.2% attendance; 82.0% consent rate, n = 2475). Nine hundred ninety-five children participated at age 4 years, 795 at age 6 years, and 699 at age 8 years. Analyses included 652 children with genotype, adiposity, and appetite data. MAIN OUTCOMES AND MEASURES Outcomes were body mass index and body-fat phenotypes measured from anthropometry (ages 4, 6, and 8 years) and bioelectrical impedance (ages 6 and 8 years). Genetic risk for obesity was measured using a genetic risk score composed of 32 single-nucleotide polymorphisms previously discovered in genome-wide association studies of adult body mass index. Appetite traits were measured at age 6 years with the Childrens Eating Behavior Questionnaire. RESULTS Of the 652 genotyped child participants, 323 (49.5%) were female, 58 (8.9%) were overweight, and 1 (0.2%) was obese. Children at higher genetic risk for obesity had higher baseline body mass index and fat mass compared with lower genetic risk peers, and they gained weight and fat mass more rapidly during follow-up. Each SD increase in genetic risk score was associated with a 0.22-point increase in BMI at age-4 baseline (for the intercept, unstandardized path coefficient B = 0.22 [95% CI, 0.06-0.38]; P = .008. Children with higher genetic risk scores also gained BMI points more rapidly from ages 4 to 6 years (B = 0.11 [95% CI, 0.03-0.20]; P = .01 ; β = 0.12) and from 6 to 8 years (B = 0.09 [95% CI, 0.00-0.19]; P = .05; β = 0.10), compared with their lower genetic risk peers. Children at higher genetic risk had higher levels of alleged obesogenic appetite traits than peers with lower genetic risk at age 6 years, but appetite traits did not mediate genetic associations with weight gain. The sum of the 5 indirect effects was B = -0.001 (95% CI, -0.02 -0.01); P = .86; β = 0.00. CONCLUSIONS AND RELEVANCE Genetic risk for obesity is associated with accelerated childhood weight gain. Interventions targeting childhood weight gain may provide one path to mitigating genetic risk. However, middle childhood appetite traits may not be a promising target for such interventions. Studies of early-childhood samples are needed to test whether appetite traits explain how genetic risks accelerate growth earlier in development.

Women's weight and disordered eating in a large Norwegian community sample: the Nord-Trøndelag Health Study (HUNT).

Objectives An increasing part of the population is affected by disordered eating (DE) even though they do not meet the full eating disorder (ED) criteria. To improve treatment in the range of weight-related disorders, there is a need to improve our knowledge about DE and relevant correlates of weight problems such as underweight, overweight and obesity. However, studies investigating DE and weight problems in a wide range of ages in the general population have been lacking. This paper explores DE, weight problems, dieting and weight dissatisfaction among women in a general population sample. Design Cross-sectional study. Setting The third survey of the Nord-Trøndelag Health Study (HUNT3). Participants The population included 27 252 women, aged 19–99 years, with information on DE outcomes and covariates. Outcomes DE was assessed with an 8-item version of the Eating Attitude Test and the Eating Disorder Scale-5. Body mass index (BMI) was objectively measured. Data on dieting and weight dissatisfaction were collected from self-reported questionnaires and analysed across weight categories. Crude and adjusted logistic and multinomial logistic regression models were used. Results High rates of overweight (38%) and obesity (23%) were found. DE was associated with weight problems. In women aged <30 years, 11.8% (95% CI 10.3 to 13.1) reported DE, and 12% (95% CI 11.5 to 12.6) reported DE in women aged >30 years. In those of younger ages (19–29 years), lower weight predicted DE, while increasing weight predicted DE in older aged women (30–99 years). The majority of women were dissatisfied with their weight (58.8%), and 54.1% of the women reported dieting. Neither BMI status nor age was associated with dieting or weight dissatisfaction. Conclusions A high prevalence of DE was observed, and findings suggest that weight problems and DE are not distinct from one another. Dieting was associated with womens weight dissatisfaction, rather than with actual weight. This requires further investigations about directionality of effects.

Catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment on social development in young children

Children with histories of disorganized attachment exhibit diverse problems, possibly because disorganization takes at least two distinctive forms as children age: controlling-punitive and controlling-caregiving. This variation in the developmental legacy of disorganization has been attributed primarily to variations in childrens rearing experiences. Here an alternative explanation of these divergent sequelae of disorganization is evaluated: one focused on genotype. Structural equation modeling was applied to data on 704 Norwegian children to test whether the catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment, which was measured dimensionally at 4 years of age using the Manchester Child Attachment Story Task, on changes in aggressive behavior and social competence from ages 4 to 6. Children who scored high on disorganization and were homozygous for the valine allele displayed significantly greater increases in aggression and decreases in self-oriented social skills (e.g., self-regulation and assertiveness) over time than did their disorganized counterparts carrying the methionine allele, whereas disorganized children carrying the methionine allele increased their other-oriented social skill (e.g., cooperation and responsibility) scores more than did valine-homozygous children. These results are consistent with the controlling-punitive and controlling-caregiving behaviors observed in disorganized children, suggesting that the childrens genotype contributed to variations in the social development of disorganized children.

Challenges in detecting and diagnosing substance use in women in the acute psychiatric department: a naturalistic cohort study

BackgroundThis study examines sex differences in substance use and substance use disorder in the acute psychiatric department, and possible interactions between sex and clinical and social factors associated with this phenomenon.MethodsData concerning substance use were collected in a naturalistic cohort study (n = 384, 51.6% male, 48.4% female) in an acute psychiatric department. Recent intake of substances at admission, diagnosis of substance use disorder and demographic and socioeconomic information were recorded. At admission, serum and urine samples were analysed for substance use and breath analysis was performed for alcohol levels.ResultsTwice as many men as women were diagnosed with substance use disorder, whereas there were no gender differences in the number of positive toxicology screenings. Toxicology screening revealed the use of non-prescribed medication with addiction potential in 40% of both female and male patients many of whom did not report this in the admission interview. A low level of education in men and absence of parental responsibility in women showed a statistically significant interaction with a current diagnosis of substance use disorder.ConclusionsDespite no sex differences in positive toxicology screenings in the acute psychiatric department, twice as many men as women are diagnosed with substance use disorders. The use of prescription drugs with addiction potential was widely under-reported by both sexes, in patients with no prescriptions for the medications. Women with no parental responsibility are overrepresented among those diagnosed with substance use disorder, as are men with a low level of education.Trial registrationThe study is registered with the ClinicalTrials.gov identifier NCT01415323

Change in parenting, change in student-teacher relationships, and oxytocin receptor gene (OXTR): Testing a Gene-×-Environment (G×E) Hypothesis in Two Samples

Prior research suggests that parenting affects children’s relationships, including those with teachers, although there is variation across individuals in such effects. Given evidence suggesting that oxytocin may be particularly important for the quality of social relationships, we tested the hypotheses (a) that change in parenting from 4 to 6 years of age influences and predicts change in the student–teacher relationship from 6 to 8 years of age and (b) that this effect is moderated by a polymorphism related to the child’s oxytocin receptor gene (OXTR), rs53576. In 2 studies, participants included, respectively, 652 socioeconomically diverse Norwegian children from a community sample (50.8% male; mean age of 54.9 months at first assessment) and 559 such children from 8 different U.S. locales (49.0% male; approximately 54 months at the first assessment). Norwegian results showed that change in parenting predicted change in student–teacher relationships, but only in the case of children homozygous for the A allele of rs53576 and in a manner consistent with differential-susceptibility theory: for AA carriers, when parenting changed for the worse, so did children’s relationship with teachers, whereas when parenting changed for the better, the teacher–child relationships improved accordingly. Such G×E findings could not be replicated in the American sample. Results are discussed in terms of 2 contrasting models of Person-×-Environment interaction (differential susceptibility and diathesis stress) and potential reasons for failure to replicate.

Age and Gender Differences in Authorship among University Hospital Physicians in Sweden, Norway and Italy (The HOUPE Study)

Background: For decades there has been a prominent gender gap in the number publications among physicians in academic medicine. Increased recruitment of women into medicine and a new generation work force that emphasize work -life balance can contribute to narrow this gap. Aims: The present study investigates whether younger hospital physicians may display less gender differences in authorship of scientific publications compared to t hose older of age. Methodology: Baseline cross-sectional survey data among senior consultants (N=1379) working at public university hospitals in three European countries, participating in the HOUPE study (Health and Organization among University hospital Physicians in Short communication

Pharmacological treatment and adherence one week prior to acute psychiatric admissions

Background and aims: To describe use of and adherence to psychotropic medication 1 week prior to acute admission to a psychiatric inpatient department. Methods: All acute inpatient admissions to a department serving a catchment area were included. Results and conclusions: Of the 227 admissions, 158 were prescribed psychotropic medication and 129 of the 158 had taken at least 75% of the prescribed dose. Among 59 patients with affective disorders, 23 were not prescribed medication prior to admission and two refused medication, while the rest were adherent. Conclusion: The high adherence to medication 1 week prior to admission might be related to increased experience of serious symptoms. Lack of opportunity to receive pharmacological treatment is a major problem.

Serum N-Desmethylcitalopram Concentrations are Associated with the Clinical Response to Citalopram of Patients with Major Depression

Objective Citalopram (CITA) is a widely used and well-tolerated selective serotonin reuptake inhibitor. The aim of the study was to evaluate the possible influences of serum concentrations of CITA and its major metabolite n-desmethylcitalopram (NDCITA) on the efficacy and tolerability of CITA in patients with major depressive disorder. Methods The study included 46 outpatients with major depressive disorder who received CITA. The efficacy and tolerability were assessed for 6 weeks. Serum CITA and NDCITA levels were measured at the 4th week. Results The HDRS17 total scores of the patients with high NDCITA and CITA & NDCITA concentrations showed a more significant reduction compared to the patients with expected and low serum NDCITA and CITA & NDCITA concentrations. However, we did not observe a correlation between the serum concentrations and the side effects of CITA, NDCITA, and CITA & NDCITA. Conclusion Our results suggested the potential contribution of NDCITA to the antidepressant effect of CITA. Further studies involving larger clinical samples are required to confirm the impact of serum NDCITA concentrations on the efficacy of CITA.