Abstract Background Childhood maltreatment (CM) has been linked to poor emotional intelligence (EI) and psychosocial functioning (PSF) in patients with bipolar disorder (BD). However, no study has investigated whether EI mediates the relationship between CM and PSF in patients with BD. Here, we aimed to assess the association of CM with EI and PSF in euthymic patients with BD compared with healthy controls (HCs). Methods We assessed 124 euthymic participants with a BD diagnosis and 124 HCs by means of the Mayer–Salovey–Caruso Emotional Intelligence Test, the Functioning Assessment Short Test and the Childhood Trauma Questionnaire. Linear regression models were constructed using CM categorized as no-CM, low/moderate-CM and high-CM. We subsequently assessed whether EI mediates the relationship between CM and PSF. Results Compared with HCs, patients with BD reported higher rates of CM and lower rates of PSF and EI. In the BD group, subjects who exhibited low/moderate CM obtained lower levels of PSF and EI than those with no-CM and high-CM levels. The regression models demonstrated that, compared with the no-CM category, the low/moderate CM category was inversely associated with EI strategic area scores in patients with BD. However, EI did not mediate the relationship between CM and PSF. Conclusions Low/moderate-CM was associated with the worst EI scores in BD. However, we did not observe any mediating effect of EI on the relationship between CM and PSF. Our results emphasize the importance of assessing CM in mental health and suggest that targeted therapies should be administered to affected patients.
Abstract Background The European Psychiatric Association (EPA) undertook a study to investigate treatment preferences of European psychiatrists towards Bipolar Disorder (BD), as part of the Ambassador programme series of surveys. Methods We conducted a cross-sectional online survey among psychiatrists and psychiatry trainees from 40 European countries. The questionnaire contained clinical vignettes of different phases of BD including manic, rapid cycling, mixed, hypomanic, and depressive episodes, for both initial and subsequent treatment strategies. Results The final sample consisted of 654 participants, from Central and Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE). The majority preferred pharmacotherapy, most commonly as a combination of two or three drugs to treat all phases of the BD, with lithium being the most preferred option in all phases. Among antipsychotics, olanzapine and quetiapine were the most commonly chosen. Antidepressants were applied in almost 20% of responses for the depressive phase. Psychosocial interventions were not systematically implemented, particularly during manic and mixed episodes, but when recommended, the most common approaches included psychoeducation, cognitive behavioural therapy (CBT) in up to 40% in depressive phase, and lifestyle recommendations. However, latent class analysis identified four different classes of prescribers. Conclusions Psychiatrists showed broadly similar pharmacological treatment preferences for BD, with frequent use of lithium-based combination therapies and limited implementation of psychosocial interventions, although latent class analysis revealed distinct prescribing profiles. These findings support the need for enhanced dissemination of evidence-based guidelines and greater integration of psychosocial approaches in BD care.
Despite the existence of effective public mental health (PMH) interventions, only a minority across the European region receive treatment for mental health conditions (MHCs). Even fewer receive interventions to prevent MHC-associated impacts, with negligible coverage of interventions to prevent MHCs, or promote mental well-being and resilience. Various reasons account for implementation failure which breaches the right to health and results in population scale preventable suffering, broad impacts and associated economic costs. Public mental health involves a population approach to improve coverage, outcomes and coordination of PMH interventions. Required actions to scale up PMH implementation include effectively making the case through assessment of PMH need, highlighting economic impacts of PMH implementation failure and improved coverage, and coordinated advocacy and leadership. Public mental health practice involves the use of PMH needs assessment to inform choice of interventions, policy development, and required coverage and resources for effective PMH intervention delivery by different sectors. This is supported by the collection of PMH-relevant data. Further actions to scale up PMH implementation include adopting human rights-based approaches and legislation, PMH training to different sectors and improved population PMH literacy, maximizing existing resources, settings-based and integrated approaches, use of digital technology, prioritizing interventions with large population impact, and implementation-focused research. Scaled up PMH implementation results in broad population impacts, achievement of a range of policy objectives, sustainable reduction in impacts of MHCs and promotion of mental well-being across the population of the European region. Associated economic savings also make PMH practice an essential part of sustainable economic development.
Challenging macrotrends in recent decades have characterised population mental health across the globe, with apparent deterioration in adolescent mental health, as well as underfunded, inequitable, and inefficient psychiatric care systems [1]. Unnecessary delays to treatment are widespread, with systemic difficulties, such as clinician burnout, a dearth of funding, and staff shortages, negatively impacting mental health care across Europe and beyond [2]. With limited clinician time and resources available, new methods for improving mental health care are an urgent priority. Digital technologies, and particularly recent advances in the capabilities of artificial intelligence (AI), offer potential to address some of these challenges, thereby transforming approaches to mental health care.
Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, with symptoms that remit or persist over time. Biological mechanisms underlying symptom change remain poorly understood, though epigenetic processes, like DNA methylation (DNAm), may serve as dynamic biomarkers of clinical outcomes. We examined change in DNAm in children and adolescents with and without ADHD, including differences between remitted and persistent ADHD. Methods We analyzed 219 saliva samples from 94 participants (aged 9.5–14.5 years) attending two to three waves of NICAP (Neuroimaging of the Children’s Attention Project). DNAm was profiled using the Infinium MethylationEPIC BeadChip. Linear mixed models adjusted for age, sex, medication, batch, and cell-proportion assessed longitudinal change. Comparisons included (1) individuals with versus without ADHD, (2) persistent or remitted ADHD versus without ADHD, and (3) persistent versus remitted ADHD. False discovery rate correction controlled for multiple testing (FDR-adjusted-p < 0.05). Results Comparison (1) showed null findings after correction for multiple testing. In contrast to those without ADHD (2), the average DNAm was statistically different at 2 sites in persistent ADHD (FDR-adjusted-p < 0.05) and 3 sites in remitted ADHD (FDR-adjusted-p < 0.03), and methylation of 3 additional CpGs differentially changed in persistent ADHD (FDR-adjusted-p < 0.04). Remitted differed from persistent ADHD (3) at 4 CpGs, including cg21443143 (ZFAT), which showed a decline over time. Gene enrichment links findings to brain structures and function, though these did not survive multiple testing. Conclusions Our study identified several epigenetic differences between remitted and persistent ADHD outcomes from typical development, and from each other. Given the early stage of this research, our findings warrant further prospective epigenome-wide studies into these diagnostic trajectories.
