Journal of Affective Disorders 148 (2013) 129–135
Contents lists available at SciVerse ScienceDirect
Journal of Affective Disorders
0165-03
http://d
n Corr
Medical
02478-9
E-m
journal homepage: www.elsevier.com/locate/jad
Brief report
Antidepressant-associated mood-switching and transition
from unipolar major depression to bipolar disorder: A review
Ross J. Baldessarini a,b,n, Gianni L. Faedda b,c,d, Emanuela Offidani e, Gustavo H. Vázquez b,f,
Ciro Marangoni g, Giulia Serra h, Leonardo Tondo b,i
a Department of Psychiatry, Harvard Medical School, Boston, MA, USA
b International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
c Lucio Bini Mood Disorders Center, New York, NY, USA
d Department of Child & Adolescent Psychiatry–Child Study Center, New York University Medical Center, USA
e Department of Psychology, University of Bologna, Bologna, Italy
f Department of Neurosciences, University of Palermo, Buenos Aires, Argentina
g Department of Psychiatry, University of Bologna, Italy
h 23*Department of Psychiatry, University (La Sapienza) of Rome and Sant’Andrea Hospital, Rome, Italy
i Lucio Bini Mood Disorders Center, Cagliari, Sardinia, Italy
a r t i c l e i n f o
Article history:
Received 5 October 2012
Accepted 23 October 2012
Available online 6 December 2012
Keywords:
Antidepressants
Bipolar disorder
Depression
Diagnostic conversion
Mood-switches
27/$ - see front matter & 2012 Elsevier B.V. A
x.doi.org/10.1016/j.jad.2012.10.033
esponding author at: McLean Hospital, Depar
School, Mailman Research Center, Rm 314, 1
106, USA. Tel.: þ1 617 855 3203; fax: þ1 61
ail address: [email protected]
a b s t r a c t
Objectives: Compare reported rates of mood-shifts from major depression to mania/hypomania/mixed-
states during antidepressant (AD)-treatment and rates of diagnostic change from major depressive
disorder (MDD) to bipolar disorder (BPD).
Methods: Searching computerized literature databases, followed by summary analyses.
Results: In 51 reports of patients diagnosed with MDD and treated with an AD, the overall risk of mood-
switching was 8.18% (7837/95,786) within 2.3972.99 years of treatment, or 3.42 (95% CI: 3.34–3.50)
%/year. Risk was 2.6 (CI: 2.5–2.8) times greater with/without AD-treatment by meta-analysis
of 10 controlled trials. Risk increased with time up to 24 months of treatment, with no secular change
(1968–2012). Incidence rates were 4.5 (CI: 4.1–4.8)-times greater among juveniles than adults (5.62/
1.26 %/year; po0.0001). In 12 studies the overall rate of new BPD-diagnoses was 3.29% (1928/56,754)
within 5.38 years (0.61 [0.58–0.64] %/year), or 5.6-times lower (3.42/0.61) than annualized rates of
mood-switching.
Conclusions: AD-treatment was associated with new mania-like responses in 8.18% of patients
diagnosed with unipolar MDD. Contributions to mood-switching due to unrecognized BPD versus
mood-elevating pharmacological effects, as well as quantitative associations betw ...
The study examined the psychological impact of the COVID-19 pandemic in the Philippines by surveying 1879 individuals online from March 28 to April 12, 2020. It found that 16.3% reported moderate to severe psychological impact from the outbreak, with 16.9% reporting moderate to severe depressive symptoms and 28.8% reporting moderate to severe anxiety levels. Female gender, younger age, being single or a student, poor health, worry, and family concerns were associated with greater psychological impact. Having good health, confidence in doctors, and older children were associated with less impact. The factors identified could help develop effective psychological support strategies during the pandemic.
11. Identifying the Elements of the Limitations & ImplicationsGo tBenitoSumpter862
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
11. Identifying the Elements of the Limitations & ImplicationsGo tSantosConleyha
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
DP due to CMD and suicidal behaviour_Rahman et al_2016Syed Rahman
This study examined the association between disability pension (DP) due to common mental disorders and subsequent suicidal behavior using data from Swedish nationwide registers. The study cohort included 46,515 individuals aged 19-64 who received a DP due to conditions like depression, anxiety or stress in 2005. The individuals were followed through 2010 to assess suicide attempts requiring hospitalization and completed suicides. The study found that having a main DP diagnosis of depression, or a secondary diagnosis of substance abuse or personality disorder, were risk factors for later suicidal behavior. Receiving a full-time versus part-time DP was also associated with increased suicide attempt risk in some groups. The results suggest certain DP diagnoses and characteristics may help identify those at higher risk of suicide who warrant
Contents lists available at ScienceDirectPsychiatry ResearAlleneMcclendon878
Contents lists available at ScienceDirect
Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres
Factors associated with depression, anxiety, and PTSD symptomatology
during the COVID-19 pandemic: Clinical implications for U.S. young adult
mental health
Cindy H. Liu (PhD)a,c,d,⁎, Emily Zhang (MA)a,c, Ga Tin Fifi Wong (BA)a,c, Sunah Hyun (PhD)a,c,
Hyeouk “Chris” Hahm (PhD)b,c
a Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
b Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
c School of Social Work, Boston University, Boston, MA, USA
d Harvard Medical School
A R T I C L E I N F O
Keywords:
Psychological stress, Loneliness
University health services
Social support
Ethnicity
COVID-19
Depression
Anxiety
PTSD
A B S T R A C T
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S.
young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898
participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of
emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents
reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥
10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of
COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of de-
pression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety
symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not
from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian
Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less
likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management
for COVID-19-related mental health problems.
1. Introduction
The COVID-19 pandemic that has upended the lives of individuals
worldwide escalated in the U.S. beginning in March of 2020. Although
research on acute and widescale stressors (e.g., natural disasters), de-
monstrates severe implications for mental health (Kessler et al., 2008),
there is no precedent for understanding the mental health effects due to
COVID-19, as prospective studies investigating the effects of a pan-
demic are virtually non-existent. In particular, the identification of risk
factors associated with depression, anxiety, and post-traumatic stress
disorder (PTSD) among U.S. young adults (18-30 years) during the
pandemic is urgently needed. Comprising more than one-third of the
current U.S. workforce, young adults (often referred to as “Millennials”
and “Generation Z”) will be a dominant workforce grou ...
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
The study examined the psychological impact of the COVID-19 pandemic in the Philippines by surveying 1879 individuals online from March 28 to April 12, 2020. It found that 16.3% reported moderate to severe psychological impact from the outbreak, with 16.9% reporting moderate to severe depressive symptoms and 28.8% reporting moderate to severe anxiety levels. Female gender, younger age, being single or a student, poor health, worry, and family concerns were associated with greater psychological impact. Having good health, confidence in doctors, and older children were associated with less impact. The factors identified could help develop effective psychological support strategies during the pandemic.
11. Identifying the Elements of the Limitations & ImplicationsGo tBenitoSumpter862
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
11. Identifying the Elements of the Limitations & ImplicationsGo tSantosConleyha
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
DP due to CMD and suicidal behaviour_Rahman et al_2016Syed Rahman
This study examined the association between disability pension (DP) due to common mental disorders and subsequent suicidal behavior using data from Swedish nationwide registers. The study cohort included 46,515 individuals aged 19-64 who received a DP due to conditions like depression, anxiety or stress in 2005. The individuals were followed through 2010 to assess suicide attempts requiring hospitalization and completed suicides. The study found that having a main DP diagnosis of depression, or a secondary diagnosis of substance abuse or personality disorder, were risk factors for later suicidal behavior. Receiving a full-time versus part-time DP was also associated with increased suicide attempt risk in some groups. The results suggest certain DP diagnoses and characteristics may help identify those at higher risk of suicide who warrant
Contents lists available at ScienceDirectPsychiatry ResearAlleneMcclendon878
Contents lists available at ScienceDirect
Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres
Factors associated with depression, anxiety, and PTSD symptomatology
during the COVID-19 pandemic: Clinical implications for U.S. young adult
mental health
Cindy H. Liu (PhD)a,c,d,⁎, Emily Zhang (MA)a,c, Ga Tin Fifi Wong (BA)a,c, Sunah Hyun (PhD)a,c,
Hyeouk “Chris” Hahm (PhD)b,c
a Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
b Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
c School of Social Work, Boston University, Boston, MA, USA
d Harvard Medical School
A R T I C L E I N F O
Keywords:
Psychological stress, Loneliness
University health services
Social support
Ethnicity
COVID-19
Depression
Anxiety
PTSD
A B S T R A C T
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S.
young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898
participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of
emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents
reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥
10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of
COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of de-
pression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety
symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not
from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian
Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less
likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management
for COVID-19-related mental health problems.
1. Introduction
The COVID-19 pandemic that has upended the lives of individuals
worldwide escalated in the U.S. beginning in March of 2020. Although
research on acute and widescale stressors (e.g., natural disasters), de-
monstrates severe implications for mental health (Kessler et al., 2008),
there is no precedent for understanding the mental health effects due to
COVID-19, as prospective studies investigating the effects of a pan-
demic are virtually non-existent. In particular, the identification of risk
factors associated with depression, anxiety, and post-traumatic stress
disorder (PTSD) among U.S. young adults (18-30 years) during the
pandemic is urgently needed. Comprising more than one-third of the
current U.S. workforce, young adults (often referred to as “Millennials”
and “Generation Z”) will be a dominant workforce grou ...
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
Depression is a state of feeling sad, miserable and down in the dumps with loss of self-confidence. Depression despite being a serious condition in all age groups is more common and significant in the
geriatric population as it is associated with morbidity and mortality. The cause of depression is multifactorial. Various scales have been developed to assess depression of which the Geriatric Depression
Scale is most suited for elderly population and those with dementia. In our study, we aim to analyse the prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care hospital and determine the factors influencing depression in them. The study was an Observational study carried out on 51 elderly patients over the age of 60 years attending the outpatient departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the prevalence of depression. A
self-designed questionnaire considering various factors causing depression was administered to determine
the factors influencing depression. It was found that among 51 elders in the age group of 60 to 80 years,
58.8% were depressed of which 54% were males and 68% were females. Financial fears regarding future
and income insufficiency were the most important factors contributing to depression. This shows that
monetary fear is a major factor resulting in depression. The government and other organizations must
ensure that better support both financial and other services like healthcare are provided to the elderly in
order to prevent depressive illnesses.
Sample 3 bipolar on female adult populationNicole Valerio
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Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Xx psychological impact of clinical treatment after breast cancer diagnosis inYelmi Reni Putri SY
This study evaluated the psychological impact of breast cancer treatment over three years in younger patients aged 38-50. Psychological tests were administered at several time points to measure distress, anxiety, anger, and depression. The results showed that emotional regulation and resilience improved how patients dealt with their diagnosis and treatment. However, vulnerability was detected, especially around 12 months post-diagnosis and after treatment ended. Overall psychological well-being fluctuated over the three-year period. Maintaining a normal lifestyle after treatment was linked to better survival outcomes. The study highlighted the emotional challenges faced by younger breast cancer patients.
This systematic review and meta-analysis examines the evidence for the effectiveness of psychological interventions in reducing internalized stigma among adults with schizophrenia spectrum disorders. The review identified 27 studies that met eligibility criteria. Meta-analysis of 18 studies found a statistically significant overall effect in lowering internalized stigma. Subgroup analysis found Narrative Enhancement and Cognitive Therapy to have a statistically significant and highly homogenous effect. In conclusion, most psychological interventions are successful in reducing internalized stigma, especially NECT, and combining multiple therapies may be more beneficial.
This study examined factors related to posttraumatic stress symptoms (PTSS) in pediatric cancer patients and their caregivers. The researchers analyzed surveys from 31 patient-caregiver dyads. They found that patient-reported PTSS was predicted by self-reported worry, while caregiver-reported patient PTSS was predicted by the caregiver's perception of the patient's physical appearance. Additionally, caregiver-reported caregiver PTSS was predicted by the caregiver's report of the patient's psychosocial functioning. The results suggest discrepancies between how patients and caregivers view factors related to PTSS.
Introduction: Depression in the elderly has disastrous implications that not only lowers quality of life, but it also has an impact on the prognosis of other chronic conditions, exacerbating disability. As estimated by WHO, depression occurs in 7% of the general elderly population and the same in India is 9.3%. This study was undertaken to know the prevalence of depression among the geriatric age group with Dependency as risk factor in villages of our field practice area.
Methodology: It’s a Cross sectional study of 251 geriatric population. The selection of villages was done through Simple random sampling and all the villagers of age above 60 years were included in the study. The identification of depression was carried out using the Geriatric Depression Scale (GDS). The dependency was calculated using the Barthel Index
Results: From our study it is found that the prevalence of depression and dependency among the geriatric population in our study area is 43% and 29% respectively. The Barthel score among depressed were also less(median (IQR) Barthel score: depressed - 65(50,85) ; not depressed -70(60,89); p value - <0.001 ). Nearly 80% of the females who were categorized as dependent were depressed (p value – 0.006). Multivariate logistic regression for depression upon Barthel score, age and gender shown significance OR for Barthel score but later after adjusting for other two factors, the AOR was not significant.
Conclusion: The study makes us understand the importance of analysing the dependency status while screening for the mental health status of the elderly person. This also gives us the idea to include the same in the interventions those are carried for improving the quality of life of elderly
Key Words: Geriatric, depression, dependency, GDS, Barthel index
This document summarizes a study that assessed the prevalence of anxiety and depression in tuberculosis patients and its impact on their quality of life. Some key findings include:
- 37.1% of tuberculosis patients were found to have anxiety and 37.1% had depression according to the Hospital Anxiety and Depression Scale, compared to only 8.6% and 2.9% respectively in the control group.
- Quality of life parameters like perceived health, relationships, and occupational role were found to be significantly impacted in tuberculosis patients compared to healthy individuals.
- Higher levels of anxiety and depression were found in tuberculosis patients who had been undergoing treatment for less than 3 months compared to those being treated for longer durations.
· Journal List
· HHS Author Manuscripts
· PMC5626643
J Affect Disord. Author manuscript; available in PMC 2019 Jan 1.
Published in final edited form as:
J Affect Disord. 2018 Jan 1; 225: 395–398.
Published online 2017 Aug 15. doi: 10.1016/j.jad.2017.08.023
PMCID: PMC5626643
NIHMSID: NIHMS902372
PMID: 28850853
Quantitative genetic analysis of anxiety trait in bipolar disorder
J Contreras,1 E Hare,3 G Chavarría,2 and H Raventós1,2
Author informationCopyright and License informationDisclaimer
The publisher's final edited version of this article is available at J Affect Disord
See other articles in PMC that cite the published article.
Go to:
Abstract
Background
Bipolar disorder type I (BPI) affects approximately 1% of the world population. Although genetic influences on bipolar disorder are well established, identification of genes that predispose to the illness has been difficult. Most genetic studies are based on categorical diagnosis. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders.
Methods
We studied 619 individuals, 568 participants from 61 extended families and 51 unrelated healthy controls. The sample was 55% female and had a mean age of 43.25 (SD 13.90; range 18–78).
Heritability and genetic correlation of the trait scale from the Anxiety State and Trait Inventory (STAI) was computed by using the general linear model (SOLAR package software).
Results
we observed that anxiety trait meets the following criteria for an endophenotype of bipolar disorder type I (BPI): 1) association with BPI (individuals with BPI showed the highest trait score (F=15.20 [5,24], p=0.009), 2) state-independence confirmed after conducting a test-retest in 321 subjects, 3) co-segregation within families 4) heritability of 0.70 (SE: 0.060), p=2.33×10−14 and 5) genetic correlation with BPI was 0.20, (SE=0.17, p=3.12×10−5).
Limitations
Confounding factors such as comorbid disorders and pharmacological treatment could affect the clinical relationship between BPI and anxiety trait. Further research is needed to evaluate if anxiety traits are specially related to BPI in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness.
Conclusions
Anxiety trait is a heritable phenotype that follows a normal distribution when measured not only in subjects with BPI but also in unrelated healthy controls. It could be used as an endophenotype in BPI for the identification of genomic regions with susceptibility genes for this disorder.
Keywords: Bipolar disorder, Endophenotype, Genetics, Heritability, Anxiety, Central Valley of Costa Rica
Go to:
Introduction
Estimates of the prevalence of bipolar I disorder have ranged from 0.8% to 1.6% of the general population (Berns and Nemeroff, 2003). Although the genetic participation is well established, the identification of genes has remained elusive. Imprecision of the phenotype might ...
· Journal List
· HHS Author Manuscripts
· PMC5626643
J Affect Disord. Author manuscript; available in PMC 2019 Jan 1.
Published in final edited form as:
J Affect Disord. 2018 Jan 1; 225: 395–398.
Published online 2017 Aug 15. doi: 10.1016/j.jad.2017.08.023
PMCID: PMC5626643
NIHMSID: NIHMS902372
PMID: 28850853
Quantitative genetic analysis of anxiety trait in bipolar disorder
J Contreras,1 E Hare,3 G Chavarría,2 and H Raventós1,2
Author informationCopyright and License informationDisclaimer
The publisher's final edited version of this article is available at J Affect Disord
See other articles in PMC that cite the published article.
Go to:
Abstract
Background
Bipolar disorder type I (BPI) affects approximately 1% of the world population. Although genetic influences on bipolar disorder are well established, identification of genes that predispose to the illness has been difficult. Most genetic studies are based on categorical diagnosis. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders.
Methods
We studied 619 individuals, 568 participants from 61 extended families and 51 unrelated healthy controls. The sample was 55% female and had a mean age of 43.25 (SD 13.90; range 18–78).
Heritability and genetic correlation of the trait scale from the Anxiety State and Trait Inventory (STAI) was computed by using the general linear model (SOLAR package software).
Results
we observed that anxiety trait meets the following criteria for an endophenotype of bipolar disorder type I (BPI): 1) association with BPI (individuals with BPI showed the highest trait score (F=15.20 [5,24], p=0.009), 2) state-independence confirmed after conducting a test-retest in 321 subjects, 3) co-segregation within families 4) heritability of 0.70 (SE: 0.060), p=2.33×10−14 and 5) genetic correlation with BPI was 0.20, (SE=0.17, p=3.12×10−5).
Limitations
Confounding factors such as comorbid disorders and pharmacological treatment could affect the clinical relationship between BPI and anxiety trait. Further research is needed to evaluate if anxiety traits are specially related to BPI in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness.
Conclusions
Anxiety trait is a heritable phenotype that follows a normal distribution when measured not only in subjects with BPI but also in unrelated healthy controls. It could be used as an endophenotype in BPI for the identification of genomic regions with susceptibility genes for this disorder.
Keywords: Bipolar disorder, Endophenotype, Genetics, Heritability, Anxiety, Central Valley of Costa Rica
Go to:
Introduction
Estimates of the prevalence of bipolar I disorder have ranged from 0.8% to 1.6% of the general population (Berns and Nemeroff, 2003). Although the genetic participation is well established, the identification of genes has remained elusive. Imprecision of the phenotype might ...
Dep with medical illness-by Dr.Swapnil AgrawalSwapnil Agrawal
This document discusses depression that occurs comorbidly with medical illnesses such as cardiovascular disease and diabetes. It notes that depression is common in patients with these conditions, affecting around 20% of those with CAD and 25% of those with diabetes. Depression is associated with worse health outcomes in these patients, including increased mortality and morbidity, poorer treatment adherence, and worse prognosis. The document explores some of the biological mechanisms of this association, such as effects on the autonomic nervous system, HPA axis, platelet activation and insulin resistance. It emphasizes the need for screening and treatment of depression in medically ill patients in order to improve their overall health.
More than 1 in 5 people in conflict areas experience mental health issuesΔρ. Γιώργος K. Κασάπης
New estimates from the WHO find that some 22% of people in conflict areas around the world suffer from a mental health problem. Here’s more from the report:
•By disease type: 13% of people experienced mild forms of depression, PTSD, and anxiety, while some 5% of people experienced severe forms of those disorders.
•By age: Those over the age of 70 in conflict zones experienced the highest rates of depression and anxiety compared to the general population and those of other ages in conflict areas.
•A takeaway: The global estimates are higher than previously thought, according to the authors, who stress the need for mental health care and intervention in conflict-affected countries.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Assignment 2 Tests of SignificanceThroughout this assignmen.docxkarenahmanny4c
Assignment 2: Tests of Significance
Throughout this assignment you will review mock studies. You will needs to follow the directions outlined in the section using SPSS and decide whether there is significance between the variables. You will need to list the five steps of hypothesis testing (as covered in the lesson for Week 6) to see how
every
question should be formatted. You will complete all of the problems. Be sure to cut and past the appropriate test result boxes from SPSS under each problem and explain what you will do with your research hypotheses.
All calculations should be coming from your SPSS
. You will need to submit the SPSS output file to get credit for this assignment. This file will save as a .spv file and will need to be in a single file. In other words, you are not allowed to submit more than one output file for this assignment.
The five steps of hypothesis testing when using SPSS are as follows:
State your research hypothesis (H
1
) and null hypothesis (H
0
).
Identify your significance level (.05 or .01)
Conduct your analysis using SPSS.
Look for the valid score for comparison. This score is usually under ‘Sig 2-tail’ or ‘Sig. 2’. We will call this “p”.
Compare the two and apply the following rule:
If “p” is < or = significance level, than you reject the null.
Be sure to explain to the reader what this means in regards to your study. (Ex: will you recommend counseling services?)
* Be sure that your answers are clearly distinguishable. Perhaps you bold your font or use a different color.
This assignment is due no later than Sunday of Week 6 by 11:55 pm ET. Save the file in the following format: [your last name_SOCI332_A2]. The file must be a word file.
t Tests
t Test for a Single Sample (20 points)
Open SPSS
Enter the number of activities of daily living performed by the depressed clients studied in #1 in the Data View window.
In the Variable View window, change the variable name to “ADL” and set the decimals to zero.
Click Analyze
à
Compare Means
à
One-Sample T test
à
the arrow to move “ADL” to the Variable(s) window.
Enter the population mean (17) in the “Test Value” box.
Click OK.
1.
Researches are interested in whether depressed people undergoing group therapy will perform a different number of activities of daily living after group therapy. The researchers have randomly selected 12 depressed clients to undergo a 6-week group therapy program.
Use the five steps of hypothesis testing to determine whether the average number of activities of daily living (shown below) obtained after therapy is significantly different from a mean number of activities of 17 that is typical for depressed people. (Clearly indicate each step).
Test the difference at the .05 level of significance and at the .01 level (in SPSS this means you change the “confidence level” from 95% to 99%).
As part of Step 5, indicate whether the behavioral scientists should recommend group therapy for all depressed people based.
Assignment 2 Strategic Action PlansThere are some elements miss.docxkarenahmanny4c
Assignment 2: Strategic Action Plans
There are some elements missing from the action plan in
Table 9.1
in your text book
.
If the EMR system is to be integrated with similar systems at local hospitals, and the physicians fully utilize its data-sharing capabilities, representatives from the hospitals must be drawn into this implementation process.
(Moseley III, George B. .
Managing Health Care Business Strategy
. Jones & Bartlett Publishers, May 2008. p. 251).
Write a three page report answering the following questions:
What elements (at least two) are missing from the action plan in Table 9.1 for the EMR system? Justify your choice.
Describe the activities that should be implemented to address the missing elements.
Describe where these activities would be added to the list (relative to the other activities already listed).
Specify exactly which people from the hospitals and practice will participate in these new activities and justify your choice.
Assignment 2 Grading Criteria
Maximum Points
Identified and explained at least two missing elements from the action plan.
25
Discussed what activities should be implemented to address the missing elements.
25
Identified where in the list the activities should be added and justified response.
10
Explained which people from the hospital /practice should participate in the new activities and justified choice.
25
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation.
15
Total:
100
.
Assignment 2 Successful Domestic Company Goes Global! Due Week 6 .docxkarenahmanny4c
Assignment 2: Successful Domestic Company Goes Global!
Due Week 6 and worth 280 points
Imagine that you are the CEO of a successful domestic company. In the last 6 months, many potential clients in foreign countries have expressed a desire to conduct business with you. You know that in order for your company to grow, you will have to expand overseas. You have recently attended a local three (3)-day international trade exposition and have gathered many brochures on the foreign companies interested in doing business with your company.
After meeting with the Executive Committee of your successful domestic company, you decide that you will need to identify a minimum of two (2) countries for expansion and two (2) expatriates whom you will send into the chosen countries. The selected expatriates will learn about the countries’ cultures and business activities there. You must prepare a report for the potential employees who may want to take an overseas assignment, the Executive Committee, and the Board of Directors.
Use the Internet and Strayer Library to research possible countries for expansion. Next, conduct research on leveraging expatriates over country nationals for business overseas. Finally, research books that could help expatriates in their transition to working overseas.
Note:
You may create and / or assume all necessary assumptions needed for the completion of this assignment.
Write an eight to ten (8-10) page paper in which you:
Create a guide to leveraging expatriates. The guide should include four to six (4-6) sources that address benefits and challenges of sending expatriates to other countries.
Examine the major benefits that this report can provide for the organization, and suggest two (2) uses for the information contained therein. Justify your response.
Analyze the major factors (e.g., distance, cultural background, knowledge of the related countries, languages spoken, relatives who may live in another country, etc.) that would influence your choice of countries into which your company would expand. Recommend two (2) countries for expansion. Provide a rationale for your response.
Determine three (3) criteria that you would consider when deciding which employees to send abroad. Justify your response.
Propose the major methods and / or incentives you would use in order to encourage the selected employees to become expatriates. Provide a rationale for your response.
Recommend one (1) strategy to ensure that both the Executive Committee and the Board of Directors are committed to the expansions. Justify your response.
Recommend two (2) books that the selected expatriates should take with them when they go overseas. Provide a rationale for your response.
Outline a guide for expatriates who will reside within another country for one to two (1-2) years. The related guide should cover the following topics: selecting items to pack, accommodating a vehicle (i.e., leave behind or send overseas), shipping or selling furniture, mo.
Assignment 2 Research Proposal Draft (due date Sunday December 4).docxkarenahmanny4c
This 3-page research proposal draft is due December 4th and must address the following sections: an introduction providing background and significance of the research problem, a clear statement of the problem and purpose of the study, at least one research question and hypothesis identifying the study variables and how they will be operationally defined.
Assignment 2 Required Assignment 2—Implementation of Sustainabili.docxkarenahmanny4c
Assignment 2: Required Assignment 2—Implementation of Sustainability in an Organization
All consumers and firms affect sustainability in different ways, either directly or indirectly. In practicing sustainability, a firm could create value for consumers, investors, and other stakeholders, such as the community in which the firm operates within its value chain. In addition, a firm engaging in good sustainable practices can fulfill the needs of its customers, earn a profit, and preserve the environment. This assignment will allow you, as a consumer, to explore how you can impact sustainability.
Tasks:
Propose a sustainability investment plan to improve the performance of your work group or organization or an organization you hope to work for. The investment can be made in human resources, in expansion of tangible or intangible assets toward new uses, or in capital equipment or new technology.
Analyze how the investment plan achieves the following:
Contributes to the mission of the company
Expands rewards for all major components of the value chain, which should include the company, employees, suppliers, and customers
Generates wealth or value and is sustainable over time
Evaluates and anticipates risks associated with the investment
Organize your work to create a 2- to 3-page professional memo in a Microsoft Word document outlining your investment plan to the director and an 8- to 10-slide Microsoft PowerPoint presentation script with complete endnotes explaining your recommendations to employees in your work group. Follow APA standards for citation of sources.
Submission Details:
Save your Microsoft Word document as word doc and your Microsoft PowerPoint ppt.
By
Wednesday, November 15, 2016
, submit your documents to the
M5: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
1.
Proposed a substantial investment plan to improve the performance of your work group or organization or an organization you hope to work for.
2.
Analyzed how the business plan contributes to the mission of the company.
3.
Analyzed how the business plan expands rewards for all major components of the value chain, which should include the company, employees, suppliers, and customers.
4.
Analyzed how the business plan generates wealth or value and is sustainable over time.
5.
Analyzed how the business plan evaluates and anticipates risks associated with the investment.
6.
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.
.
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Sample 3 bipolar on female adult populationNicole Valerio
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Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Xx psychological impact of clinical treatment after breast cancer diagnosis inYelmi Reni Putri SY
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This systematic review and meta-analysis examines the evidence for the effectiveness of psychological interventions in reducing internalized stigma among adults with schizophrenia spectrum disorders. The review identified 27 studies that met eligibility criteria. Meta-analysis of 18 studies found a statistically significant overall effect in lowering internalized stigma. Subgroup analysis found Narrative Enhancement and Cognitive Therapy to have a statistically significant and highly homogenous effect. In conclusion, most psychological interventions are successful in reducing internalized stigma, especially NECT, and combining multiple therapies may be more beneficial.
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Introduction: Depression in the elderly has disastrous implications that not only lowers quality of life, but it also has an impact on the prognosis of other chronic conditions, exacerbating disability. As estimated by WHO, depression occurs in 7% of the general elderly population and the same in India is 9.3%. This study was undertaken to know the prevalence of depression among the geriatric age group with Dependency as risk factor in villages of our field practice area.
Methodology: It’s a Cross sectional study of 251 geriatric population. The selection of villages was done through Simple random sampling and all the villagers of age above 60 years were included in the study. The identification of depression was carried out using the Geriatric Depression Scale (GDS). The dependency was calculated using the Barthel Index
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This document summarizes a study that assessed the prevalence of anxiety and depression in tuberculosis patients and its impact on their quality of life. Some key findings include:
- 37.1% of tuberculosis patients were found to have anxiety and 37.1% had depression according to the Hospital Anxiety and Depression Scale, compared to only 8.6% and 2.9% respectively in the control group.
- Quality of life parameters like perceived health, relationships, and occupational role were found to be significantly impacted in tuberculosis patients compared to healthy individuals.
- Higher levels of anxiety and depression were found in tuberculosis patients who had been undergoing treatment for less than 3 months compared to those being treated for longer durations.
· Journal List
· HHS Author Manuscripts
· PMC5626643
J Affect Disord. Author manuscript; available in PMC 2019 Jan 1.
Published in final edited form as:
J Affect Disord. 2018 Jan 1; 225: 395–398.
Published online 2017 Aug 15. doi: 10.1016/j.jad.2017.08.023
PMCID: PMC5626643
NIHMSID: NIHMS902372
PMID: 28850853
Quantitative genetic analysis of anxiety trait in bipolar disorder
J Contreras,1 E Hare,3 G Chavarría,2 and H Raventós1,2
Author informationCopyright and License informationDisclaimer
The publisher's final edited version of this article is available at J Affect Disord
See other articles in PMC that cite the published article.
Go to:
Abstract
Background
Bipolar disorder type I (BPI) affects approximately 1% of the world population. Although genetic influences on bipolar disorder are well established, identification of genes that predispose to the illness has been difficult. Most genetic studies are based on categorical diagnosis. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders.
Methods
We studied 619 individuals, 568 participants from 61 extended families and 51 unrelated healthy controls. The sample was 55% female and had a mean age of 43.25 (SD 13.90; range 18–78).
Heritability and genetic correlation of the trait scale from the Anxiety State and Trait Inventory (STAI) was computed by using the general linear model (SOLAR package software).
Results
we observed that anxiety trait meets the following criteria for an endophenotype of bipolar disorder type I (BPI): 1) association with BPI (individuals with BPI showed the highest trait score (F=15.20 [5,24], p=0.009), 2) state-independence confirmed after conducting a test-retest in 321 subjects, 3) co-segregation within families 4) heritability of 0.70 (SE: 0.060), p=2.33×10−14 and 5) genetic correlation with BPI was 0.20, (SE=0.17, p=3.12×10−5).
Limitations
Confounding factors such as comorbid disorders and pharmacological treatment could affect the clinical relationship between BPI and anxiety trait. Further research is needed to evaluate if anxiety traits are specially related to BPI in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness.
Conclusions
Anxiety trait is a heritable phenotype that follows a normal distribution when measured not only in subjects with BPI but also in unrelated healthy controls. It could be used as an endophenotype in BPI for the identification of genomic regions with susceptibility genes for this disorder.
Keywords: Bipolar disorder, Endophenotype, Genetics, Heritability, Anxiety, Central Valley of Costa Rica
Go to:
Introduction
Estimates of the prevalence of bipolar I disorder have ranged from 0.8% to 1.6% of the general population (Berns and Nemeroff, 2003). Although the genetic participation is well established, the identification of genes has remained elusive. Imprecision of the phenotype might ...
· Journal List
· HHS Author Manuscripts
· PMC5626643
J Affect Disord. Author manuscript; available in PMC 2019 Jan 1.
Published in final edited form as:
J Affect Disord. 2018 Jan 1; 225: 395–398.
Published online 2017 Aug 15. doi: 10.1016/j.jad.2017.08.023
PMCID: PMC5626643
NIHMSID: NIHMS902372
PMID: 28850853
Quantitative genetic analysis of anxiety trait in bipolar disorder
J Contreras,1 E Hare,3 G Chavarría,2 and H Raventós1,2
Author informationCopyright and License informationDisclaimer
The publisher's final edited version of this article is available at J Affect Disord
See other articles in PMC that cite the published article.
Go to:
Abstract
Background
Bipolar disorder type I (BPI) affects approximately 1% of the world population. Although genetic influences on bipolar disorder are well established, identification of genes that predispose to the illness has been difficult. Most genetic studies are based on categorical diagnosis. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders.
Methods
We studied 619 individuals, 568 participants from 61 extended families and 51 unrelated healthy controls. The sample was 55% female and had a mean age of 43.25 (SD 13.90; range 18–78).
Heritability and genetic correlation of the trait scale from the Anxiety State and Trait Inventory (STAI) was computed by using the general linear model (SOLAR package software).
Results
we observed that anxiety trait meets the following criteria for an endophenotype of bipolar disorder type I (BPI): 1) association with BPI (individuals with BPI showed the highest trait score (F=15.20 [5,24], p=0.009), 2) state-independence confirmed after conducting a test-retest in 321 subjects, 3) co-segregation within families 4) heritability of 0.70 (SE: 0.060), p=2.33×10−14 and 5) genetic correlation with BPI was 0.20, (SE=0.17, p=3.12×10−5).
Limitations
Confounding factors such as comorbid disorders and pharmacological treatment could affect the clinical relationship between BPI and anxiety trait. Further research is needed to evaluate if anxiety traits are specially related to BPI in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness.
Conclusions
Anxiety trait is a heritable phenotype that follows a normal distribution when measured not only in subjects with BPI but also in unrelated healthy controls. It could be used as an endophenotype in BPI for the identification of genomic regions with susceptibility genes for this disorder.
Keywords: Bipolar disorder, Endophenotype, Genetics, Heritability, Anxiety, Central Valley of Costa Rica
Go to:
Introduction
Estimates of the prevalence of bipolar I disorder have ranged from 0.8% to 1.6% of the general population (Berns and Nemeroff, 2003). Although the genetic participation is well established, the identification of genes has remained elusive. Imprecision of the phenotype might ...
Dep with medical illness-by Dr.Swapnil AgrawalSwapnil Agrawal
This document discusses depression that occurs comorbidly with medical illnesses such as cardiovascular disease and diabetes. It notes that depression is common in patients with these conditions, affecting around 20% of those with CAD and 25% of those with diabetes. Depression is associated with worse health outcomes in these patients, including increased mortality and morbidity, poorer treatment adherence, and worse prognosis. The document explores some of the biological mechanisms of this association, such as effects on the autonomic nervous system, HPA axis, platelet activation and insulin resistance. It emphasizes the need for screening and treatment of depression in medically ill patients in order to improve their overall health.
More than 1 in 5 people in conflict areas experience mental health issuesΔρ. Γιώργος K. Κασάπης
New estimates from the WHO find that some 22% of people in conflict areas around the world suffer from a mental health problem. Here’s more from the report:
•By disease type: 13% of people experienced mild forms of depression, PTSD, and anxiety, while some 5% of people experienced severe forms of those disorders.
•By age: Those over the age of 70 in conflict zones experienced the highest rates of depression and anxiety compared to the general population and those of other ages in conflict areas.
•A takeaway: The global estimates are higher than previously thought, according to the authors, who stress the need for mental health care and intervention in conflict-affected countries.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Similar to Journal of Affective Disorders 148 (2013) 129–135Contents li (17)
Assignment 2 Tests of SignificanceThroughout this assignmen.docxkarenahmanny4c
Assignment 2: Tests of Significance
Throughout this assignment you will review mock studies. You will needs to follow the directions outlined in the section using SPSS and decide whether there is significance between the variables. You will need to list the five steps of hypothesis testing (as covered in the lesson for Week 6) to see how
every
question should be formatted. You will complete all of the problems. Be sure to cut and past the appropriate test result boxes from SPSS under each problem and explain what you will do with your research hypotheses.
All calculations should be coming from your SPSS
. You will need to submit the SPSS output file to get credit for this assignment. This file will save as a .spv file and will need to be in a single file. In other words, you are not allowed to submit more than one output file for this assignment.
The five steps of hypothesis testing when using SPSS are as follows:
State your research hypothesis (H
1
) and null hypothesis (H
0
).
Identify your significance level (.05 or .01)
Conduct your analysis using SPSS.
Look for the valid score for comparison. This score is usually under ‘Sig 2-tail’ or ‘Sig. 2’. We will call this “p”.
Compare the two and apply the following rule:
If “p” is < or = significance level, than you reject the null.
Be sure to explain to the reader what this means in regards to your study. (Ex: will you recommend counseling services?)
* Be sure that your answers are clearly distinguishable. Perhaps you bold your font or use a different color.
This assignment is due no later than Sunday of Week 6 by 11:55 pm ET. Save the file in the following format: [your last name_SOCI332_A2]. The file must be a word file.
t Tests
t Test for a Single Sample (20 points)
Open SPSS
Enter the number of activities of daily living performed by the depressed clients studied in #1 in the Data View window.
In the Variable View window, change the variable name to “ADL” and set the decimals to zero.
Click Analyze
à
Compare Means
à
One-Sample T test
à
the arrow to move “ADL” to the Variable(s) window.
Enter the population mean (17) in the “Test Value” box.
Click OK.
1.
Researches are interested in whether depressed people undergoing group therapy will perform a different number of activities of daily living after group therapy. The researchers have randomly selected 12 depressed clients to undergo a 6-week group therapy program.
Use the five steps of hypothesis testing to determine whether the average number of activities of daily living (shown below) obtained after therapy is significantly different from a mean number of activities of 17 that is typical for depressed people. (Clearly indicate each step).
Test the difference at the .05 level of significance and at the .01 level (in SPSS this means you change the “confidence level” from 95% to 99%).
As part of Step 5, indicate whether the behavioral scientists should recommend group therapy for all depressed people based.
Assignment 2 Strategic Action PlansThere are some elements miss.docxkarenahmanny4c
Assignment 2: Strategic Action Plans
There are some elements missing from the action plan in
Table 9.1
in your text book
.
If the EMR system is to be integrated with similar systems at local hospitals, and the physicians fully utilize its data-sharing capabilities, representatives from the hospitals must be drawn into this implementation process.
(Moseley III, George B. .
Managing Health Care Business Strategy
. Jones & Bartlett Publishers, May 2008. p. 251).
Write a three page report answering the following questions:
What elements (at least two) are missing from the action plan in Table 9.1 for the EMR system? Justify your choice.
Describe the activities that should be implemented to address the missing elements.
Describe where these activities would be added to the list (relative to the other activities already listed).
Specify exactly which people from the hospitals and practice will participate in these new activities and justify your choice.
Assignment 2 Grading Criteria
Maximum Points
Identified and explained at least two missing elements from the action plan.
25
Discussed what activities should be implemented to address the missing elements.
25
Identified where in the list the activities should be added and justified response.
10
Explained which people from the hospital /practice should participate in the new activities and justified choice.
25
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation.
15
Total:
100
.
Assignment 2 Successful Domestic Company Goes Global! Due Week 6 .docxkarenahmanny4c
Assignment 2: Successful Domestic Company Goes Global!
Due Week 6 and worth 280 points
Imagine that you are the CEO of a successful domestic company. In the last 6 months, many potential clients in foreign countries have expressed a desire to conduct business with you. You know that in order for your company to grow, you will have to expand overseas. You have recently attended a local three (3)-day international trade exposition and have gathered many brochures on the foreign companies interested in doing business with your company.
After meeting with the Executive Committee of your successful domestic company, you decide that you will need to identify a minimum of two (2) countries for expansion and two (2) expatriates whom you will send into the chosen countries. The selected expatriates will learn about the countries’ cultures and business activities there. You must prepare a report for the potential employees who may want to take an overseas assignment, the Executive Committee, and the Board of Directors.
Use the Internet and Strayer Library to research possible countries for expansion. Next, conduct research on leveraging expatriates over country nationals for business overseas. Finally, research books that could help expatriates in their transition to working overseas.
Note:
You may create and / or assume all necessary assumptions needed for the completion of this assignment.
Write an eight to ten (8-10) page paper in which you:
Create a guide to leveraging expatriates. The guide should include four to six (4-6) sources that address benefits and challenges of sending expatriates to other countries.
Examine the major benefits that this report can provide for the organization, and suggest two (2) uses for the information contained therein. Justify your response.
Analyze the major factors (e.g., distance, cultural background, knowledge of the related countries, languages spoken, relatives who may live in another country, etc.) that would influence your choice of countries into which your company would expand. Recommend two (2) countries for expansion. Provide a rationale for your response.
Determine three (3) criteria that you would consider when deciding which employees to send abroad. Justify your response.
Propose the major methods and / or incentives you would use in order to encourage the selected employees to become expatriates. Provide a rationale for your response.
Recommend one (1) strategy to ensure that both the Executive Committee and the Board of Directors are committed to the expansions. Justify your response.
Recommend two (2) books that the selected expatriates should take with them when they go overseas. Provide a rationale for your response.
Outline a guide for expatriates who will reside within another country for one to two (1-2) years. The related guide should cover the following topics: selecting items to pack, accommodating a vehicle (i.e., leave behind or send overseas), shipping or selling furniture, mo.
Assignment 2 Research Proposal Draft (due date Sunday December 4).docxkarenahmanny4c
This 3-page research proposal draft is due December 4th and must address the following sections: an introduction providing background and significance of the research problem, a clear statement of the problem and purpose of the study, at least one research question and hypothesis identifying the study variables and how they will be operationally defined.
Assignment 2 Required Assignment 2—Implementation of Sustainabili.docxkarenahmanny4c
Assignment 2: Required Assignment 2—Implementation of Sustainability in an Organization
All consumers and firms affect sustainability in different ways, either directly or indirectly. In practicing sustainability, a firm could create value for consumers, investors, and other stakeholders, such as the community in which the firm operates within its value chain. In addition, a firm engaging in good sustainable practices can fulfill the needs of its customers, earn a profit, and preserve the environment. This assignment will allow you, as a consumer, to explore how you can impact sustainability.
Tasks:
Propose a sustainability investment plan to improve the performance of your work group or organization or an organization you hope to work for. The investment can be made in human resources, in expansion of tangible or intangible assets toward new uses, or in capital equipment or new technology.
Analyze how the investment plan achieves the following:
Contributes to the mission of the company
Expands rewards for all major components of the value chain, which should include the company, employees, suppliers, and customers
Generates wealth or value and is sustainable over time
Evaluates and anticipates risks associated with the investment
Organize your work to create a 2- to 3-page professional memo in a Microsoft Word document outlining your investment plan to the director and an 8- to 10-slide Microsoft PowerPoint presentation script with complete endnotes explaining your recommendations to employees in your work group. Follow APA standards for citation of sources.
Submission Details:
Save your Microsoft Word document as word doc and your Microsoft PowerPoint ppt.
By
Wednesday, November 15, 2016
, submit your documents to the
M5: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
1.
Proposed a substantial investment plan to improve the performance of your work group or organization or an organization you hope to work for.
2.
Analyzed how the business plan contributes to the mission of the company.
3.
Analyzed how the business plan expands rewards for all major components of the value chain, which should include the company, employees, suppliers, and customers.
4.
Analyzed how the business plan generates wealth or value and is sustainable over time.
5.
Analyzed how the business plan evaluates and anticipates risks associated with the investment.
6.
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.
.
Assignment 2 Social MobilityFor this assignment, you will trace y.docxkarenahmanny4c
For this assignment, the student is asked to trace their family's history of social mobility over at least three generations by examining factors like education, wealth, and occupation. They should consider how race and gender may have influenced mobility patterns. The student is expected to describe their family's mobility experience, explain differences in mobility levels between generations, predict their own mobility trajectory and that of future children, and support their analysis with academic sources. They will be graded on thoroughly addressing these points in a clear, concise, and academically honest manner.
Assignment 2 Reflections on Racial DiscriminationFranklin hears a.docxkarenahmanny4c
Assignment 2: Reflections on Racial Discrimination
Franklin hears about people being discriminated against at the workplace and in society but rarely experiences it first hand. Cortez, on the other hand, speaks English poorly and is often subject to derogatory comments from peers and coworkers.
Reflect on your experience with racial discrimination.
Identify examples of racial discrimination and provide examples you have personally witnessed or heard about firsthand from the following three realms:
family
work place
community
Write a brief summary that includes the following:
Describe a racial incident pertaining to each realm in detail. Explain why you believe this is racial discrimination.
Explain how this situation could have been handled to avoid discrimination against those belonging to another race.
Submit your response to the
M
. Your response should be at least two pages long. All written assignments and responses should follow APA rules for attributing sources.
Assignment 2 Grading Criteria
Maximum Points
Reflection on your experiences with racial discrimination from the three listed realms (i.e., family, work place, community).
30
Provided examples of discrimination from the three listed realms.
25
Described the identified racial incident in detail, and explained why each incident is an example of discrimination.
25
Explained how these situations could have had a different outcome if the people involved had not discriminated against others.
10
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.
10
Total:
100
.
Assignment 2: Required Assignment 1—Intercultural Employee Motivation and Rewards
Culture plays a major role in the motivation of employees. Consider that though you have a mix of ethnicities on your team, you also need to be aware of cultural differences including gender, generation, and other categories of human differences.
Write an 8–10-page report on employee motivation, including a recommendation for an employee reward system that will meet the needs of the variety of cultural groups you manage based on the following motivation factors:
Job security
Professional development
Job performance
Goal setting
Employee recognition
Compensation
Discuss employee motivation as it relates to culture, and consider how you might develop a reward system that recognizes diversity and is equitable and legally sound. Support your recommendations with scholarly references.
.
Assignment 2: Required Assignment 1—Developing Communications Policy
In this assignment, you will prepare a communications policy for a company that you are familiar with or a fictitious company you create. The communications policy will map the type of communications messages (e.g., organizational or strategic changes, procedural changes, information important to organizational subgroups, confidential information, unwelcome information, etc.).
Using the module readings and the Argosy University online library resources, research requirements of and methods of creating communications policy documents.
Create a communications policy document that covers the following:
Identify the audience
Describe the media (including social media) to be used
List and explain the appropriate approvals required
Explain the tools and tactics to be used
In developing your plan, you should utilize at least five peer-reviewed articles in addition to the readings from the textbook and online resources.
.
Assignment 2 Project Paper – Comparative EssayDue Week 8 an.docxkarenahmanny4c
Assignment 2: Project Paper
–
Comparative Essay
Due Week 8 and worth 200 points
This “Assignment 2” writing assignment is a comparative essay focused on topics encountered in our HUM 111 class. The project will be based on research but will reflect your views and interpretation of the topic. This project is designed to help you stretch your mind and your abilities as an organized, innovative, and critical thinker. If approached properly, it should also be fun!
Choose one (1) of the topics from the list of topic choices below. Read the topic carefully. Write a three to four (3-4) page paper (750-1,000 words) that follows instructions and covers each part of the topic. (The title page and References list do not get included in this word count).
Note:
Your instructor may require you to submit your topic choice for approval before the end of Week 5.
For the topic you choose:
Establish a clear thesis about your topic as part of the introductory paragraph (often the thesis is the last thing one determines after doing the basic research and outline; however it will be placed in the first paragraph of your paper).
This is a comparative essay. Comparison approached properly will require some critical thinking on your part. Use a point-by-point approach for the essay. That means, if comparing subject A with subject B, don't do the first half of the essay on subject A and then the second half on subject B--that will seem like two (2) separate essays and comparisons will tend to get lost. Instead, you should be mentioning both subjects in most of your paragraphs as you compare them throughout the essay. Comparisons will identify similarities as well as contrasts.
Do not try to do everything on your two (2) subjects. You should end up narrowing your focus to a few insights and issues about the subjects being compared. And, from those fairly specific points of comparison, you will develop a thesis and glean some lessons.
Follow closely the instructions below for your specific topic.
Include a concluding paragraph at the end. This paragraph will, in some way, refer back to the thesis established in your first paragraph, since now you have demonstrated and supported it. It may be here that you also include your observations relating your study to the modern workplace or society (see your topic). Try to finish with flair!
Use at least three (3) good quality academic sources, with one (1) source being the class text.
Note:
Wikipedia
and other similar Websites do not qualify as academic resources. You are highly encouraged to use the Resource Center tab at the top of your Blackboard page.
Topic Choices
–
Choose just one (1) of the topics below:
Qualities of the Hero: Comparing Gilgamesh and Odysseus
.
Write an essay comparing these two (2) heroic figures from ancient epics of different cultures, especially focusing your analysis on the sources about their encounters with monsters: Gilgamesh encounters the monster guarding the forest, Humbaba,.
Assignment 2 Probation and Parole—Realities and PerceptionsProbat.docxkarenahmanny4c
Assignment 2: Probation and Parole—Realities and Perceptions
Probation and parole encompasses a wide variety of offenders and can be as vast and diverse as the populations the law enforcement officials oversee. As seen in the course readings, inclusion of probation and parole in the criminal justice system has been influenced by societal norms and values and can be viewed as a reflection of the current belief system.
Tasks:
By
Saturday, July 16, 2016
, in a minimum of 250 words, post to the
Discussion Area
your response to the following.
What are your current perceptions regarding corrections, probations, and parole in the United States? What are these perceptions based on?
What do you think are the people’s perceptions of probation and parole?
What is the role of the media in shaping public opinion regarding the criminal justice system, especially the probation and parole systems?
What are the pros and cons of the media’s role in shaping public opinion on probation and parole?
While performing research on the influence of media conduct, provide appropriate references.
.
Assignment 2 Physical Development in Early AdulthoodDuring earl.docxkarenahmanny4c
Assignment 2: Physical Development in Early Adulthood
During early adulthood, people begin make important life decisions in three areas: career, family, and health. Young adults establish patterns of nutrition and physical activity that can have either positive or negative effects on their physical development in later stages of adulthood. They also begin to make decisions about what career path to follow. At some point during early adulthood, individuals also choose either to marry or remain single, and decide whether or not to start a family. Consider the following example:
Jeff is 23 years old. He recently graduated from college with a business degree and took a managerial position with a midsize company. He likes his coworkers, but often finds himself bored with his work. Although he was active in college, recently he has gained about 10 pounds due to his sedentary job and lack of time to exercise. Jeff broke up with his college girlfriend after graduation, and since then he has dated a few different women, but hasn’t had another serious relationship. Jeff wonders what the remainder of his 20’s and his 30’s will bring.
Based on your reading, prepare a PowerPoint presentation that would help individuals like Jeff set goals related to career, health, and family. The presentations should discuss the relationship between lifestyle choices and health risks. In addition, it should address how factors like personality and attachment may influence both career- and family-related goals. Finally, address diversity in the presentation. Explain how your plan could be adapted to fit the needs of different socioeconomic or ethnic groups.
Your PowerPoint presentation should include an introduction, a conclusion, and detailed speaker’s notes. Include your references on one slide.
Develop a 6–8-slide presentation in PowerPoint format with speaker’s notes. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.ppt.
In order for this assignment to be compatible with TurnItIn, you will need to save your PowerPoint presentation as an Adobe PDF file. To do this, open your presentation in Microsoft PowerPoint. Choose "Save As" from the File menu, then choose "Adobe PDF". Before saving your file, click on the Options button and check the box next to "Convert Speaker Notes." Now choose to save your file. Your speaker notes will be included in your PDF file that you will submit for this assignment.
Note:
If your version of Microsoft PowerPoint does not have the option to include speaker notes, you will need to submit a Microsoft Word document that contains all information from your presentation, including the speaker notes.
By
Wednesday, April 13, 2016
, deliver your assignment to the
M2: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Developed logical and structured plan detailing specific ways young adults could set goals in the areas of career, health, and family.
30
Discussed t.
Assignment 2 Position Paper Two – Media and Society Due Week 10 a.docxkarenahmanny4c
Assignment 2: Position Paper Two – Media and Society
Due Week 10 and worth 250 points
This is the second of two (2) position papers based on the following scenario to be completed in this course.
Imagine that you are running for a state office (e.g., governor, senator, or representative) and you have to prepare a position paper for a debate on controversial issues in the news. (Select one (1) of the topics addressed in Weeks 5-9 of this class.) You will want your position paper to demonstrate critical thinking, sound logic, valid claims, personal passion, and credible support that is cited correctly because the paper will be provided to the news media before the debate and will be scrutinized by the media and reported on regarding these criteria. Your professor will serve as your close advisor whose job is to review the paper and provide feedback to you on the paper’s strengths and weaknesses.
Write a two to three (2-3) page (700 to 1,200 words) paper in which you:
Introduce your position using a thesis statement in the first paragraph, including a quote, question, or statistic from your reliable sources and an overview of the main points you will cover. (It’s important to grab the audience’s interest and inform them of what the main and support points are.)
Provide three or four (3-4) major points to support your thesis statement. (Put each major point in a separate paragraph.)
Provide one (1) paragraph in which you identify and answer an expected argument against your view.
Organized arguments and support for claims effectively.
Demonstrate personal passion for your position and critical thinking with persuasive language, sound logic, valid claims, and credible support for the claims.
Provide two to three (2-3) credible and reliable references (in addition to the text) about current events, which have been published in the last five (5) years and are cited correctly in the position paper. (Wikipedia is not an acceptable source.)
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Apply critical thinking skills to the analysis of issues involving mass media and society.
Use technology and information resources to research issues in media and society.
Write clearly and concisely about media and society using proper writing mechanics.
Note: Depending on the student’s topic selection, the outcome measured might include one of the following:
Evaluate the appropriateness of various media forms for different audiences.
Analyze selected le.
Assignment 2 Overview of Interviewing and InterrogationA criminal.docxkarenahmanny4c
Assignment 2: Overview of Interviewing and Interrogation
A criminal justice professional gathers information through effective interviews and interrogations. Ineffective victim or suspect interviews or interrogations can cost an investigator a case, and understanding the difference between an interview and an interrogation is critical in selecting an appropriate approach for a specific situation. Interviews and interrogations are dynamic, evolving situations, and developing interviewing and interrogation skills takes time and practice. Interrogation involves an accusatory, persuasive approach. Effective interviewers have the ability to quickly establish rapport with their subjects and gain complete, concise, and accurate information about crimes, additional witnesses, and suspects. Building rapport early helps take down barriers to open and clear communication, which is critical in conducting interviews and interrogations.
Submission Details:
By
Saturday, December 24, 2016
, in a minimum of 250 words, post to the
Discussion Area
your answers to the following:
What are the qualities of an effective interviewer and interrogator?
What are the purposes of interviews and interrogations?
What is the difference between an interview and an interrogation?
What is D. K. Berlo's communication process? How does it apply in the criminal justice field?
What is a purposeful interview?
By
Wednesday, January 4, 2017
, read and respond to at least two of your classmates' posts. When responding, use contradictions and counterexamples supported by class readings. You can ask questions, disagree with opinions, redirect your thoughts, or ask your classmates to rethink what they have posted and why.
Discussion Grading Criteria and Rubric
All discussion assignments in this course will be graded using a rubric. This assignment is worth 40 points. Download the discussion rubric and carefully read it to understand the expectations.
.
Assignment 2 Physical Development in Early AdulthoodDuring early .docxkarenahmanny4c
Assignment 2: Physical Development in Early Adulthood
During early adulthood, people begin make important life decisions in three areas: career, family, and health. Young adults establish patterns of nutrition and physical activity that can have either positive or negative effects on their physical development in later stages of adulthood. They also begin to make decisions about what career path to follow. At some point during early adulthood, individuals also choose either to marry or remain single, and decide whether or not to start a family. Consider the following example:
Jeff is 23 years old. He recently graduated from college with a business degree and took a managerial position with a midsize company. He likes his coworkers, but often finds himself bored with his work. Although he was active in college, recently he has gained about 10 pounds due to his sedentary job and lack of time to exercise. Jeff broke up with his college girlfriend after graduation, and since then he has dated a few different women, but hasn’t had another serious relationship. Jeff wonders what the remainder of his 20’s and his 30’s will bring.
Based on your reading, prepare a PowerPoint presentation that would help individuals like Jeff set goals related to career, health, and family. The presentations should discuss the relationship between lifestyle choices and health risks. In addition, it should address how factors like personality and attachment may influence both career- and family-related goals. Finally, address diversity in the presentation. Explain how your plan could be adapted to fit the needs of different socioeconomic or ethnic groups.
Your PowerPoint presentation should include an introduction, a conclusion, and detailed speaker’s notes. Include your references on one slide.
Develop a 6–8-slide presentation in PowerPoint format with speaker’s notes. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.ppt.
In order for this assignment to be compatible with TurnItIn, you will need to save your PowerPoint presentation as an Adobe PDF file. To do this, open your presentation in Microsoft PowerPoint. Choose "Save As" from the File menu, then choose "Adobe PDF". Before saving your file, click on the Options button and check the box next to "Convert Speaker Notes." Now choose to save your file. Your speaker notes will be included in your PDF file that you will submit for this assignment.
Note:
If your version of Microsoft PowerPoint does not have the option to include speaker notes, you will need to submit a Microsoft Word document that contains all information from your presentation, including the speaker notes.
By
Wednesday, December 14, 2016
, deliver your assignment to the
M2: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Developed logical and structured plan detailing specific ways young adults could set goals in the areas of career, health, and family.
30
Discusse.
Assignment 2 Past and Current Trends in Human ServicesIn this mod.docxkarenahmanny4c
Assignment 2: Past and Current Trends in Human Services
In this module, you explored the past and current trends in human services.
Tasks:
Using the Argosy University online library resources and the Internet, research and read about the assignment topic. In a minimum of 200 words, respond to the following:
Identify events that you believe to have greatly impacted the field of human services and discuss them in detail.
Discuss both their intended and unintended consequences.
Additionally, discuss the importance and changing shape of networking as discussed in the readings.
.
Assignment 2 RA 2 Policy Proposal PaperFor this assignment, you .docxkarenahmanny4c
Assignment 2: RA 2: Policy Proposal Paper
For this assignment, you will be building on the problem definition developed in
Module 4
and develop a policy proposal for advocacy and adoption.
Tasks:
Create a 10- to 12-page policy proposal, utilizing a minimum of five scholarly sources in your research. Address the following in your proposal:
State the social problem you wish to solve.
Analyze the policy development cycle and the influence of stakeholders throughout the process.
Discuss how the policy development cycle and the influence of stakeholders will be used to effect social change for your identified problem.
As a human services professional, examine your role in policy advocacy and coalition building for improving human services.
Describe all of the resources available to support your policy and how you would organize them.
Identify the steps you will take, including the use of social media, to build a coalition around the policy, highlighting your role in the process.
Determine a list of the different constituents you would engage to advance your policy goal.
Define the specific policy action to be pursued.
Develop the criteria for measuring the effectiveness of the policy for society if adopted.
.
Assignment 2 Midweek Production Assignment Pendente Lite Support.docxkarenahmanny4c
Assignment 2: Midweek Production Assignment: Pendente Lite Support
Parents have a legal obligation to support their minor children. This gets complicated during the pendency of a divorce since the parties are not yet divorced and thus “final” orders cannot be entered. That does not relieve the parents of their obligation and if the non-custodial parent refuses support, a Motion must be filed with the Court to have the Court order the support. Further, read the scenario below and answer the following questions too.
Richard and Susan are in the process of a divorce. They had two children together during the course of their marriage. Richard refused to pay Susan child support for their children. Susan cannot support the children on her own and needs Richard to pay child support. Prepare a motion for Pendente Lite Child Support to compel Richard to pay Susan child support. Use the template to draft the motion.
On a separate page, cite all sources using the Bluebook format.
.
Assignment 2 Miranda RightsAs you learned in your readings, befor.docxkarenahmanny4c
Assignment 2: Miranda Rights
As you learned in your readings, before interrogating a suspect in police custody, the police need to inform the suspect about his or her constitutional rights.
Tasks:
Assume you are a high-ranking official in a law enforcement agency and have ten years of experience in the field. You have been asked to make a presentation to newly sworn police officers about Miranda rights. While the rules for how and when Miranda rights should be given to suspects used to be relatively simple, they have changed dramatically over the past few years.
Utilizing the Argosy University online library, research how Miranda rights and the interpretation of the application of the Fifth and Sixth Amendments to the US Constitution have changed over time.
Prepare a 10- to 15-slide Microsoft PowerPoint presentation regarding these changes and address the following:
Describe the original Miranda case and the statements required for making a valid Miranda warning.
Explain under what circumstances Miranda rights are triggered.
Describe the changes in the Fifth and Sixth Amendments and the custodial protections that are provided under these.
Discuss the past, present, and possible future applications of the following for suspects in police custody:
The right to remain silent
The right to counsel
Submit the details in the Notes section of the presentation.
Submission Details:
Save the presentation as M4_A2_Lastname_Firstname.ppt.
By
Wednesday, October 5, 2016
, submit your presentation to the
M4: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Described the original Miranda case.
8
Accurately identified and described the four statements required to make a valid Miranda warning.
12
Accurately identified and explained the circumstances under which Miranda rights are triggered.
8
Accurately identified and described the changes in the Fifth Amendment and the custodial protections provided under it.
16
Accurately identified and described the changes in the Sixth Amendment and the custodial protections provided under it.
16
Critically analyzed and explained the past, present, and possible future applications of the right to remain silent and the right to counsel.
20
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in the accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.
20
Total:
100
.
Assignment 2: Library Research—Training Police Recruits
Chief Draper has noticed that the behavior of many of his officers reflects a lack of understanding of many basic criminal justice concepts. Last week, he received a complaint about a patrol officer with ten years of experience on the force. The complaint alleged that the officer pulled over a car for a traffic violation and allowed the driver to leave with a verbal warning after the driver gave him free football game tickets. Another complaint involved the Special Weapons and Tactics (SWAT) supervisor. In this complaint, it is alleged that the SWAT team broke down the door of a suspected drug dealer only to find that it had the wrong house. The team later found the suspected dealer at another location and arrested and interrogated him before reading the Miranda warnings. These are only a few of the complaints being reviewed, and Chief Draper believes that police recruits need more training on the following topics:
Discretion
Ethics
Probable cause
Plain view doctrine
Arrest
Good faith exception
Miranda
Reasonable suspicion
Use of force
Racial profiling
Tasks:
Prepare a 12- to 14-slide Microsoft PowerPoint presentation with your recommendations of the important points that should be addressed in the training of police recruits.
Devote at least one slide to each of the ten topics listed.
Use court cases to support your explanations.
Use the Notes section to provide for deeper exploration of each topic.
Include a cover slide and at least one slide at the end of your presentation to reference your sources, formatted in the APA style, that link back to your in-text citations and support your recommendations. See your Argosy Handbook or APA materials to properly cite your text.
Submission Details:
Save the final presentation as M2_A2_Lastname_Firstname.ppt.
By
Wednesday, June 22, 2016
, submit your final presentation to the
M2: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Prepared a Microsoft PowerPoint presentation with important recommendations on the listed topics, at le
.
How to Fix the Import Error in the Odoo 17Celine George
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A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
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at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
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In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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Walmart Business+ and Spark Good for Nonprofits.pdf
Journal of Affective Disorders 148 (2013) 129–135Contents li
1. Journal of Affective Disorders 148 (2013) 129–135
Contents lists available at SciVerse ScienceDirect
Journal of Affective Disorders
0165-03
http://d
n Corr
Medical
02478-9
E-m
journal homepage: www.elsevier.com/locate/jad
Brief report
Antidepressant-associated mood-switching and transition
from unipolar major depression to bipolar disorder: A review
Ross J. Baldessarini a,b,n, Gianni L. Faedda b,c,d, Emanuela
Offidani e, Gustavo H. Vázquez b,f,
Ciro Marangoni g, Giulia Serra h, Leonardo Tondo b,i
a Department of Psychiatry, Harvard Medical School, Boston,
MA, USA
b International Consortium for Bipolar Disorder Research,
McLean Hospital, Belmont, MA, USA
c Lucio Bini Mood Disorders Center, New York, NY, USA
d Department of Child & Adolescent Psychiatry–Child Study
Center, New York University Medical Center, USA
e Department of Psychology, University of Bologna, Bologna,
Italy
2. f Department of Neurosciences, University of Palermo, Buenos
Aires, Argentina
g Department of Psychiatry, University of Bologna, Italy
h 23*Department of Psychiatry, University (La Sapienza) of
Rome and Sant’Andrea Hospital, Rome, Italy
i Lucio Bini Mood Disorders Center, Cagliari, Sardinia, Italy
a r t i c l e i n f o
Article history:
Received 5 October 2012
Accepted 23 October 2012
Available online 6 December 2012
Keywords:
Antidepressants
Bipolar disorder
Depression
Diagnostic conversion
Mood-switches
27/$ - see front matter & 2012 Elsevier B.V. A
x.doi.org/10.1016/j.jad.2012.10.033
esponding author at: McLean Hospital, Depar
School, Mailman Research Center, Rm 314, 1
106, USA. Tel.: þ1 617 855 3203; fax: þ1 61
3. ail address: [email protected]
a b s t r a c t
Objectives: Compare reported rates of mood-shifts from major
depression to mania/hypomania/mixed-
states during antidepressant (AD)-treatment and rates of
diagnostic change from major depressive
disorder (MDD) to bipolar disorder (BPD).
Methods: Searching computerized literature databases, followed
by summary analyses.
Results: In 51 reports of patients diagnosed with MDD and
treated with an AD, the overall risk of mood-
switching was 8.18% (7837/95,786) within 2.3972.99 years of
treatment, or 3.42 (95% CI: 3.34–3.50)
%/year. Risk was 2.6 (CI: 2.5–2.8) times greater with/without
AD-treatment by meta-analysis
of 10 controlled trials. Risk increased with time up to 24
months of treatment, with no secular change
(1968–2012). Incidence rates were 4.5 (CI: 4.1–4.8)-times
greater among juveniles than adults (5.62/
1.26 %/year; po0.0001). In 12 studies the overall rate of new
BPD-diagnoses was 3.29% (1928/56,754)
within 5.38 years (0.61 [0.58–0.64] %/year), or 5.6-times lower
(3.42/0.61) than annualized rates of
mood-switching.
Conclusions: AD-treatment was associated with new mania-like
4. responses in 8.18% of patients
diagnosed with unipolar MDD. Contributions to mood-switching
due to unrecognized BPD versus
mood-elevating pharmacological effects, as well as quantitative
associations between switching and
later diagnosis of BPD not associated with AD-treatment remain
uncertain.
Limitations: Rates and definitions of mood-switching with ADs
varied greatly, exposure-times rarely
were precisely defined, and there was little information on
predictive associations between mood-
switches and BPD-diagnosis.
& 2012 Elsevier B.V. All rights reserved.
1. Introduction
Many cases of bipolar disorder (BPD) present in episodes of
major depressive disorder (MDD), accounting for approximately
half of initial episodes (Goodwin and Jamison 2007; Tondo et
al.,
2010b; Etain et al., 2012). Many such patients risk switching of
mood from depression to disruptive and potentially dangerous
manic/hypomanic, mixed, or psychotic states, sometimes in
ll rights reserved.
tment of Psychiatry, Harvard
15 Mill Street, Belmont, MA
7 855 3479.
5. (R.J. Baldessarini).
association with treatment with a mood-elevating agent, and
some require re-diagnosis to BPD (Lim et al., 2005; Visser and
Van
der Mast, 2005; Licht et al., 2008; Tondo et al., 2010a; Li et al.,
2012). Such risk may be particularly high among juvenile
depressed patients, who are more likely to be treated with
antidepressants (ADs) and stimulants before a diagnosis of BPD
is made (Martin et al., 2004; Baldessarini et al., 2005; Lim et
al.,
2005; Biederman et al., 2009; Offidani et al., 2012). Moreover,
patients who begin BPD with depressive or mixed episodes
appear to be at increased risk for long-term morbidity,
disability,
and suicide (Baldessarini et al., 2010a, 2010b, 2012b). These
considerations indicate the importance of quantifying the risk of
excessive elevation of mood and behavioral activation during
www.elsevier.com/locate/jad
www.elsevier.com/locate/jad
dx.doi.org/10.1016/j.jad.2012.10.033
dx.doi.org/10.1016/j.jad.2012.10.033
dx.doi.org/10.1016/j.jad.2012.10.033
http://crossmark.dyndns.org/dialog/?doi=10.1016/j.jad.2012.10.
033&domain=pdf
http://crossmark.dyndns.org/dialog/?doi=10.1016/j.jad.2012.10.
033&domain=pdf
http://crossmark.dyndns.org/dialog/?doi=10.1016/j.jad.2012.10.
033&domain=pdf
mailto:[email protected]
dx.doi.org/10.1016/j.jad.2012.10.033
R.J. Baldessarini et al. / Journal of Affective Disorders 148
(2013) 129–135130
6. treatment with mood-elevating drugs, and its relationship to
later
diagnoses of BPD supported by spontaneous mood-elevations
(Strober and Carlson, 1982; Akiskal et al., 1983). Finally, it
remains unclear to what extent AD-associated mood-switches
represent uncovering of potential or unrecognized BPD, or a
more
direct pharmacologic effect independent of diagnosis (Tondo
et al., 2010a; Offidani et al., 2012).
Accordingly, we carried out a systematic review of reports on
AD-associated mood-switching among patients diagnosed with
MDD, as well as of reports on diagnostic conversion from MDD
to
BPD. We aimed to clarify the rates of each phenomenon and to
seek relationships between them, as well as considering the
possible significance of AD-associated mood-switching.
2. Methods
We supplemented two recent systematic literature searches
(Tondo et al., 2010a; Offidani et al., 2012) for reports
pertaining to
manic-switching during AD-treatment and to diagnostic change
to BPD in MDD patients identified in several computerized
databases to September, 2012: Best Evidence (from 1991);
Centre
for Reviews and Dissemination; CINAHL database; Cochrane
Library;
EMBASE (from 1980); ISI database; MEDLINE-PubMed (from
1966);
PsychInfo; PsycLIT (from 1967); Thomson–Reuters; and Web-
of-
Science. The search used combinations of the following subject
headings: adolescent, adverse, antidepressant, bipolar, child,
depression, diagnosis, major depression, mania, hypomania,
mood-switch. We initially screened more than 2,000 on-line
7. abstracts; reprints of 590 potentially eligible reports were
obtained and duplicate data were excluded. Computerized
searching was supplemented by reviewing bibliographies in
reports reviewed. This process yielded an initial collection of
250 unique reports for detailed review, of which 51 pertaining
to
mood-switching and 12 pertaining to diagnostic conversion for
subjects of any age and with any study-design, based on the
occurrence of spontaneous hypomania or mania to the extent
possible with reported information. Limitations of information
reported precluded testing of heterogeneity of data pooled. Data
were pooled and analyzed by standard statistical methods, using
Statview.5 (SAS Institute; Cary, NC) and Stata.8 (StataCorp,
College
Station, TX) commercial programs.
3. Results
Rate of mood-switching with antidepressants
Reports of AD-treatment-associated mood-switching (n¼51;
Table 1) included a total of 95,786 depressed patients of a range
of
ages, treated and followed for times varying from 4 weeks to 23
years (mean: 2.3972.99 years; median: 1.00 [IQR: 0.20–3.75]).
The overall rate of mood-switching into mania, hypomania,
or mixed-states was 8.18% (7837/95,786), compared to the
mean7SD of rates from individual studies of 10.9711.4% (95%
CI: 7.73–14.1). Owing to the lack of details about exposures for
individuals, we did not adjust tabulated rates for the time-at-
risk,
which averaged 2.39 (95% CI: 1.55–3.23) years. However, an
estimated annualized rate of mood-switching was 3.42 (CI:
3.35–3.50) %/year (7837/95,786/2.39 years).
Switching rate was strongly associated with longer nominal
treatment-exposure times (overall r¼0.528, po0.0001).
8. However, this association was significant only within the initial
two years of AD-exposure (r¼0.401, p¼0.031) but not later
(r¼0.156, p¼0.489), suggesting that most of the risk was
limited
to the initial months of treatment. The time-adjusted rate of
switching within the first year of antidepressant-exposure
averaged 1.0371.26 %/month. We found no indication of a
secular trend, as switching rates were uncorrelated with the year
of reporting between 1968 and 2012 (r¼0.003, p¼0.983). Also,
rates were not higher before than during broad application of
modern antidepressants since 1990 (9.3278.94% versus
11.8712.6%, respectively; t¼0.784, p¼0.461).
Prospective studies yielded non-significantly higher rates of
AD-associated mood-switching than with retrospective designs
(11.6711.7% versus 8.38710.1%, respectively; t¼0.789,
p¼0.434)
with similar average exposure-times (4.8976.23 versus
3.3175.93
years; t ¼0.759, p¼0.452). However, AD-associated switch-
rates
were 3.0-times lower in placebo-controlled versus uncontrolled
studies (4.2074.04% versus 12.8711.9%; t¼2.22, p¼0.031);
controlled studies also involved significantly shorter exposure-
times (9.32710.6 versus 65.6777.7 months; t¼2.27, p¼0.028),
which may limit risk.
To verify an expectedly higher risk of manic-switching during
AD-treatment, we compared the data from 10 paired
assessments
with versus without such treatment or with a placebo (Prien
et al., 1973, 1984; Kane et al., 1982; Peet, 1994; Emslie et al.,
1997, 2002, 2006; Keller et al., 2001; Martin et al., 2004;
Dunner
et al., 2005). Random-effects meta-analysis indicated a highly
significant relative risk (RR) of 2.62 with/without ADs (95%
9. CI:
2.48–2.77; z¼33.6, po0.0001), with an estimated number-
needed-to-harm (NNH) of 21 (CI: 19–22). This relationship
remained similar and highly significant with two unusually
large
studies (Peet, 1994; Martin et al., 2004) omitted individually or
together to avoid their potentially distorting influences on the
analysis (RR¼2.84; CI: 2.62-3.06).
Comparison of patient-samples of adult versus juvenile ages
indicated marked differences in switch-risk. The rates were
9.33%
(7126/76,356) among juveniles versus 3.66% (711/19,430) in
adults,
with a risk-ratio (RR) of 2.55 (CI: 2.36–2.75; po0.0001).
Adjusted
for estimated exposure-times, the corresponding juvenile versus
adult incidence rates were 5.62 %/year (9.33%/1.66 years)
versus
1.26 %/year (3.66%/2.90 years), for a risk-ratio of 4.46 (CI:
4.12–4.82;
po0.0001).
Finally, multivariate linear regression modeling found that
only longer duration of treatment was significantly associated
with higher switch-rates (t¼3.77. po0.0001). Other factors not
significantly associated with switch-rates were: year of study,
prospective versus retrospective design, randomized-controlled
versus open trial, age, and total number of subjects/study
(all tr1.70; all pZ0.10).
Rates of conversion from unipolar major depression to bipolar
disorders
We also identified 12 studies with information pertaining to
10. rates of conversion of diagnoses from apparent unipolar MDD
to type I or II BPD, excluding cases involving mania/hypomania
associated only with mood-elevating treatments when these
were identified (Table 2). Based on the ratio of cases with
changed diagnoses to all subjects, the overall risk of diagnostic
change was 3.29% (1928/58,682) in an average exposure time
of 5.38 years for an incidence rate of 0.612 (CI: 0.580–0.640)
%/
year. The mean conversion rate across individual studies was
1.79
[1.10–2.48] %/year. The available data were insufficient to
support
assessment of effects of age on rates of diagnostic change.
We found a large excess of mood-switching associated with
AD-treatments versus new diagnoses of BPD, based primarily
on occurrence of spontaneous mania–hypomania. This ratio,
based on weighted proportions of switching versus new diag-
noses, unadjusted for exposure-times, was 2.95-fold (8.18%/
3.29%; w2¼1473, p o 0.0001). With rates adjusted for estimated
exposure-times (3.42 and 5.38 years, respectively), this ratio
was even greater, at 5.61 (3.42/0.61%/year; Tables 1 and 2).
Table 1
Rates of mood-switching from unipolar major depression to
mania, hypomania, or mixed-states.
Study (year) Design Initial ages Diagnostic
criteria
Initial
status
Treatments Exposure
11. (yrs)
Outcome Switch-risk Predictive factors
Cases
(n)
Subjects
(N)
%
Perris (1968) Pros Adult Clin MDD (hosp) Clin 10.0 M 18 138
13.0 Psychosis
Prien et al. (1973)a Pros Adult DSM2 MDD (hosp) IMI7Li 1.00
M 9 78 11.5 Treatments
Winokur and Morrison (1973) Pros Adult RDC MDD (hosp)
Clin 5.50 M 9 225 4.00 –
Rao and Nammalvar (1977) Retro Adult Clin MDD (hosp) Clin
4.00 M 42 122 34.4 –
Angst et al. (1978) Pros Adult ICD8 MDD (hosp) Clin 2.00 Ma
20 159 12.6 Recurrences
Van Scheyen and van Kammen (1979)a,b, Pros Adult Clin MDD
(hosp) TCAs 0.16 M 7 50 14.0 Older age
De Wilde and Doogan (1982)a Pros Adult Feighner MDD (amb)
TCA/SRI 0.08 M or m 0 21 0.00 –
Himmelhoch et al. (1982)a Pros Adult RDC MDD (amb) MAOI
0.12 M or m 0 19 0.00 –
12. Kane et al. (1982)a Pros Adult RDC MDD (amb) IMI7Li 1.42 M
or m 1 27 3.70 –
Strober and Carlson (1982) Pros 13–16 RDC MDD (hosp) Clin
0.17 M 2 56 3.57 FH, retard., psychosis
Akiskal et al. (1983) Pros Adult DSM3 MDD (amb) Clin 6.50 m
18 82 22.0 FH, retard., psychosis
Prien et al. (1984)a Pros Adult RDC MDD (amb) TCAs 1.25 M
or Mx 5 77 6.49 –
Angst (1987)a,c Pros Adult Clin MDD (hosp) Clin 1.00 M or m
29 787 3.68 –
Winokur and Wesner (1987) d Pros Adult Clin MDD (hosp) Clin
2.00 M or m 29 342 8.48 hosps., retardation
Garber et al. (1988) Pros 12–18 DSM3 Dep (hosp) e Clin 4.10
M or m 2 11 18.2 –
Kupfer et al. (1988)a Retro Adult DSM3 MDD (amb) IMI 0.75
M or m 5 197 2.54 –
Harrington et al. (1990) Retro 6–16 ClinþRDC Depressed Clin
9.25 M or m 5 52 9.62 –
Johnstone et al. (1990)a Pros Adult DSM3 MDD AMI7Li 1.75
M or m 0 27 0.00 –
McCauley et al. (1993) Pros 12–18 RDC Dep (hospþamb) f Clin
1.50 M or m 4 65 6.15 –
Menchon et al. (1993) Pros Adult RDC MDD (melancholic)
TCA/MAOI 0.50 m 26 116 22.4 Early onset
Strober et al. (1993) Pros 12–18 RDC MDD (hosp) Clin 1.00 M
13. or m 5 58 8.62 Psychosis
Geller et al., 1994 Pros 6–12 DSM3 MDD (amb) Clin 1.75 M or
m 25 79 31.6 FH, severity
Kovacs et al., 1994 Pros 8–14 DSM3 MDDþDys Clin 5.00 M or
m 25 115 21.7 –
Peet et al. (1994)a Review Adult Various MDD (RCTs)
TCAs/SRIs 0.17 M 88 12962 0.68 –
Coryell et al. (1995)g,h Pros Adult RDC MDD (hospþamb) Clin
3.75 M or m 84 583 14.4 Psychosis, FH, youth
Rao et al. (1995) Pros 12–18 RDCþDSM3 MDD (hospþamb)
Clin 3.50 M or m 5 26 19.2 –
Tierney et al. (1995) Retro 8–18 DSM3R MDD SRI 0.19 M 2 33
6.06
Howland (1996) Retro Adult Clin MDD Clin 0.08 M or m 9 182
4.95 –
Kovacs (1996i Pros 8–13 RDCþDSM3 MDD (amb) Clin 3.75 M
or m 19 92 20.6 –
McConville et al. (1996) Pros 12–18 DSM3R MDD SRI 0.23 M
1 13 7.69 –
Emslie et al. (1997) Pros 7–17 DSM3R MDD7 Anxiety SRI 0.15
M 3 48 6.25
Amsterdam (1998)a Retro Adult DSM4 MDD SNRI 0.12 M or m
0 42 0.00 –
Weissman et al. (1999) Pros 6–12 RDC MDD Clin 1.00 M or m
5 83 6.02 FH
14. Goldberg et al. (2001) Pros Adult DSM4 MDD (hosp) Clin 7.50
M or m 30 74 40.5 Psychosis
Keller et al. (2001) Pros 12–18 DSM4 MDD TCA/SRI 0.17 m 1
188 0.53 –
Emslie et al. (2002) Pros 8–18 DSM4 MDD SRI 0.17 m 1 109
0.92 –
Ghaemi et al. (2004)a Pros Adult DSM4 MDD Clin 1.00 M or m
0 37 0.00 –
Martin et al. (2004)a Retro 5–29 ICD9 MDD (amb) TCAs/SRIs
0.79 M or m 6918 73511 9.41 Youth
R
.J.
B
a
ld
e
ssa
rin
i
e
t
a
l.
/
17. (N)
%
Angst et al. (2005)j Pros Adult RDC MDD (hosp) Clin 11.7 M
or m 121 309 39.2 Early onset
Dunner et al. (2005)a Retro Adult DSM4 MDD (amb) SNRIs
0.16 m 2 1139 0.18 –
Kochman et al. (2005) Pros 7–17 DSM4 MDD (hosp) Clin 1.11
M or m 35 80 43.8 Soft hypomania
Shirazi and Alaghband-Rad (2005) Pros 8–17 DSM4
MDD7Anxiety SRI 0.12 M 5 30 16.7 –
Emslie et al. (2006) Pros 12–17 DSM4 MDD SRI 0.23 M or m 5
216 2.31 –
Wada et al. (2006) Retro Adult DSM4 MDD Clin 3.00 M or m
37 282 13.1 FH
Grof (2007) Retro Adult DSM4 Depression Clin 1.00 M or m –
– 18.5 –
Brent et al. (2008) Pros 12–18 DSM4 MDD SRI/SNRI 0.23 m 1
334 0.30 –
Beesdo et al. (2009)k Pros 14–24 DSM4 Hx of MDD Clin 5.00
M or m 26 649 4.01 Early onset
Zimmerman et al. (2009)l Pros 14–24 DSM4 Hx of MDD Clin
5.00 M or m 35 470 7.45 Soft hypomania
Bechdolf et al. (2010) Retro 15–24 DSM4 MDD Clin 0.79 M or
m 6 173 3.47 –
18. Fiedorowicz et al. (2012) Pros Adult DSM4 Hx of MDD Clin
9.95 M or m 108 550 19.6 Soft hypomania
Tondo et al. (2012)m Pros Adult DSM4 Initial MDD (amb) Clin
0.25 M or m 4 668 0.60 Antidepressants
Totals/means (n¼51) – – Initial MDD Antidepressants
2.3972.99
[1.55–3.23]
M/Mx/m 7837 95,786 8.18
[8.00–8.36]
–
In these 51 studies, the 95,786 subjects were considered
initially to have unipolar major depressive disorder (MDD).
Individual reported rates are not adjusted for exposure-times,
the weighted-average of which was 2.39 years.
The overall risk of mood-switching was 8.18% (7837/95,786);
the mean across studies was 10.9711.4, and the approximate
observed rate was 3.42 %/year (7837/95,786/2.39; [CI: 3.34–
3.50]).
Abbreviations: amb, ambulatory; AMI, amitriptyline; BD,
bipolar disorder type I or II; Clin, clinical; DSM3 or DSM4,
APA Diagnostic and Statistical Manual (editions III or IV);
Dys, dysthymia; FH, Family history;Hosp, initially
hospitalized for depression or more or longer subsequent
hospitalizations; Hx, history of; IMI, imipramine; Li, lithium
carbonate; M, mania; m, hypomania; MDD, major depressive
disorder; MAOI, monoamine oxidase inhibitor;
Mx, mixed-state; Pros, prospective; Retard, psychomotor
retardation, often with hypersomnia; RDC, Research Diagnostic
19. Criteria; Retro, retrospective; SNRI, serotonin-norepinephrine
reuptrate inhibitor; SRI, serotonin-reuptake
inhibitor; TCA, tricyclic antidepressant.
Notable factors associated with emergence of mania or
hypomania included: family history of bipolar disorder; younger
at illness-onset; initial or previous mild hypomanic symptoms;
initial psychotic features; initial
psychomotor retardation.
a Studies (n¼14) on unipolar MDD patients included in review
by Tondo et al. (2010a).
b 12/159 (7.55%) changed to schizoaffective diagnoses.
c Exposure-times are for BD as well as unipolar patients. There
was a nonsignificant increased risk (2.66%–4.67%; p¼0.08)
following introduction of antidepressants (since 1960). Similar
results were reported later for the
same database (Angst (1985)).
d Report includes 225 cases also reported by Winokur and
Morrison (1973).
e Includes depression with other pediatric disorders, including
conduct and adjustment, as well as MDD.
f Includes depression with other pediatric disorders.
g Similar results from the same database were reported later
(Akiskal et al., 1995).
h Rate of conversion of BD-II–BD-I: 12.8%.
i Also reviews other published reports reviewed above.
j Of initially BD-II cases, 41.2% converted to BD-I.
k All conversions occurred within 6 months.
l Subjects drawn from large German community sample;
depression before age 17 had 2.2-times greater risk of later BD;
conversion rate¼2.5%/year�5 years, then c.a. 0.5%/year
thereafter; half of the risk was
20. by 2.5 years.
m The rate of diagnostic conversion was 19/2328 (0.82%) over
16.7 years of risk-exposure; currently agitated depressed
patients were not given ADs to minimize switch-risk.
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22. 3
2
Table 2
Rates of diagnostic conversion from unipolar major depressive
disorder. to bipolar I or II disorder.
Study Age groups Newly bipolar Total subjects Years Rate
(%/year)
Akiskal et al. (1983) Adults 23 206 13.0 0.86
Akiskal et al. (1995) Adults 70 559 11.0 1.14
Coryell et al. (1995) Adults 39 381 10.0 1.02
Martin et al. (2004) Age 5–29 934 50,610 5.00 0.37
Angst et al. (2005) Adults 121 309 20.4 1.92
Holma et al. (2008) Adults 29 248 5.00 2.34
Kamat et al. (2008) Adults 94 1360 3.00 2.30
Biederman et al. (2009) Juveniles 29 105 7.00 3.95
Dudek et al. (2012) Adults 40 122 9.30 3.52
Fiedorowicz et al. (2012) Adults 96 550 19.9 0.88
Li et al. (2012) Adults 451 3944 6.50 1.76
Tondo (2012) Adults 2 288 0.50 1.39
23. Totals/means [95% CI] – 1928 58,682 9.2276.18
[5.2913.1]
1.7971.09
[1.10–2.48]
In these 12 studies, the overall conversion (uncorrected for
exposure-time) was 3.29% (1928/58,682; [CI: 3.14–3.43). Mean
exposure time weighted by numbers of subjects
is 5.38 years, so that the weighted conversion rate is
1928/58,682/5.38¼0.61 (CI: 0.58–0.64) % per year. There may
be some shared subject-sampling in the reports by
Akiskal et al. 1995, Coryell et al. 1995, and Fiedorowicz et al.
2012, although their reported rates differed. In addition,
Salvatore et al. (2012) have found a high rate of
diagnostic conversions within 2 years of first hospitalization for
a major depressive episode with psychotic features.
R.J. Baldessarini et al. / Journal of Affective Disorders 148
(2013) 129–135 133
4. Discussion
We found new mania-like reactions (‘‘mood-switches’’) during
AD-treatment among patients diagnosed with unipolar MDD, at
an average frequency of 8.18% of cases, or approximately 3.42
%/
year of treatment (Table 1). Rates of new diagnoses of BPD
among
patients diagnosed with MDD averaged 3.29%, or 0.61 %/year
(Table 2). These findings indicate 2.5–5.6-fold excess of mood-
switches to re-diagnoses, although reported rates of both
AD-associated mood-switches and of changed diagnoses to BPD
24. are both vulnerable to ascertainment biases. In particular, it is
likely that many instances of relatively mild mood-elevation or
behavioral activation are not considered manic, hypomanic, or
mixed-states and so not counted as mood-switches (Offidani
et al., 2012). Accordingly, the ratio of excessive mood-
elevation
during AD-treatment to changed diagnoses may be even greater
than we estimated.
There was no secular change in switch-rates over the years
encountered (1968–2012) nor was risk lower since 1990, before
which tricyclic ADs, with a relatively high risk of inducing
mania,
were more widely used (Koszewska and Rybakowski, 2009;
Tondo et al., 2010a). As expected, risk of mood-switching was
higher (by 3.0-times) in uncontrolled than controlled trials,
possibly because of longer observation. Switch-risk increased
significantly within the initial, nominal 2 years of AD-
treatment,
but not thereafter (up to 4.6 years), consistent with evidence
that
most AD-associated manic reactions occur within the initial
months of treatment (Angst, 1987; Menchon et al., 1993; Post
et al., 2003; Lim et al., 2005; Fiedorowicz et al., 2012; Offidani
et al., 2012; Tondo et al., 2012). However, lack of reported
details
concerning the timing of observed mood-changes limits estima-
tion of switch-rates at specific times.
The observed ratio of mood-switching among depressed
patients exposed to ADs was 2.6-times greater in juveniles than
in adults (9.33%/3.66%). Corresponding ratios for diagnostic
change versus age-groups could not be estimated adequately
from the available data (Table 2). Information on age-related
mood-switching is important since many cases of BPD in young
patients are first detected or suspected from reactions to treat-
25. ment with ADs or other mood-elevating drugs that are
commonly
employed in the treatment of juvenile psychiatric patients
(Martin et al., 2004; Offidani et al., 2012). The observed age-
difference in switching-risk versus age, may in part reflect a
sampling artifact, in that juvenile patients are less likely than
adults to have been diagnosed with BPD; moreover, diagnosis of
BPD is less straightforward among juveniles (Martin et al.,
2004;
Offidani et al., 2012). Alternatively, earlier onset-age may
identify
a unique subgroup of patients eventually diagnosed with BPD,
with higher rates of familial mood-disorders and possibly other
psychobiological characteristics that may contribute to risk of
treatment-associated as well as spontaneous mood-elevations
(Baldessarini et al., 2012a).
In addition to the early onset-age, other factors that may be
associated with mood-switching include a family history of
mood
disorders, psychotic features, severe depression with
hospitaliza-
tion, psychomotor retardation, and mild hypomanic symptoms
(Table 1), as noted previously (Strober and Carlson, 1982;
Akiskal
et al., 1983; Perlis et al., 2010; Salvatore et al., 2012; Valentı́ et
al.,
2012).
An important, unresolved question is of the significance of
AD-associated mood-switching. Two plausible possibilities are:
[a] responses reflecting the presence of BPD, or [b] a direct
pharmacological effect of mood-elevating treatments that may
be transient, relatively rapidly reversible, and not followed by a
change in diagnosis (Reichart and Nolen, 2004; Lim et al.,
2005;
26. Joseph et al., 2009; Offidani et al., 2012). The several-fold
higher
proportion of patients with mood-switches among unipolar
MDD
patients than the rate of later re-diagnoses of BPD is consistent
with the possibility that some AD-associated mood-switches
may
represent pharmacologic reactions (AD-induced mania). It is
also
likely that AD-associated risk will be greater than spontaneous
mood-elevations regardless of cause. It is important to note that
the reported rates of re-diagnosis to BPD may be somewhat
over-
estimated if some cases involve drug-related mood-elevation
and
not only spontaneous mania–hypomania. That is the ratio of
AD-associated mood-elevations to new diagnoses of BPD may
actually be even higher than we found. A specific question
remaining is whether AD-associated mania requires a diagnosis
of BPD, or if some patients may become manic–hypomanic only
with mood-elevating treatments but not spontaneously.
To address such questions, it would be of interest to follow
large samples of depressed patients who become manic or
hypomanic during treatment with a mood-elevating agent
to determine their risk of later spontaneous mood-elevations
requiring re-diagnosis of BPD. However, such studies are rare.
One study found that 18% of 60 depressed adolescents later re-
diagnosed with BPD had previous antidepressant-associated
hypomania (Strober and Carlson, 1982). In another study,
R.J. Baldessarini et al. / Journal of Affective Disorders 148
(2013) 129–135134
diagnostic change to BPD was observed in 44% of 41 patients
27. considered initially to have MDD with treatment-associated
hypomania, compared to none without such previous reactions
(Akiskal et al., 1983). These observations leave uncertain the
risk
of re-diagnosis as BPD among depressed patients who
experience
mood-switching with AD-treatment.
Limitations of the present study include varied definitions and
rates of mood-switching with ADs, and only average or
maximum
exposure-times. Moreover, there was little information on a
putative predictive association between mood-switches and later
diagnosis of BPD among patients initially diagnosed with
unipolar
MDD, and specifically as a function of current or onset-age. In
general, the predictive value of treatment-associated mood-
switching to later diagnosis of BPD remains uncertain, as are
contributions to mood-switching of direct pharmacological
effects versus a manifestation of BPD.
The occurrence of treatment-associated mood-switching has
implications for diagnosis of BPD as well as for clinical
manage-
ment. That is, a single episode of AD-associated mood-switch
has
an uncertain relationship to the risk of future spontaneous
mood-
elevations or the need to diagnose BPD. Moreover, a single
instance of AD-associated mood-switching (and probably even a
single episode of spontaneous mania) does not seem an adequate
basis for recommending indefinitely continued mood-stabilizing
treatment (Zarin and Pass, 1987; Baldessarini, 2013).
In conclusion, AD-associated mood-switching into mania-like
states was not rare among patients diagnosed with unipolar
28. major depressive disorder, was especially likely among
juveniles,
and was much more frequent than changes of diagnosis to
bipolar
disorder. It remains uncertain when such reactions require
re-diagnosis to bipolar disorder and corresponding, …
After reading “Antidepressant-associated mood-switching and
transition from unipolar major depression to bipolar disorder: A
review in your course resources,” write a 600-750-word article
critique addressing the following questions:
1. What did you think of the article? What interesting questions
did the article raise for you?
2. How did the article relate to topics presented in the textbook?
3. What implications does the article have for the field of
psychology and for society at large?
4. Should people with bipolar disorder be encouraged to seek
treatment, even if they do not desire treatment?
5. Compare and contrast the symptoms and treatments of
unipolar depression and bipolar depression.
include a minimum of two scholarly sources library to support
your claims in addition of the article you are critiquing. In
addition to the scholarly resources from the library,
Prepare this assignment according to the guidelines found in the
APA Style Guide, located in the Student Success Center. An
abstract is not required.