Abstract Introduction and Background: According to the Centers for Disease Control and Prevention (2020), “postpartum depression is depression that occurs after having a baby which is more intense and lasts longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby.” It also states, “1 in 8 women report symptoms of depression after giving birth, about 1 in 5 (20%) women were not asked about depression during a prenatal visit, and over half (50%) of pregnant women with depression were not treated.” Purpose Statement: The purpose of this research is to investigate the connection between preventing postpartum depression or reducing postpartum depression with exercise interventions along with incorporating nursing and other healthcare professions. Literature Review: The design of studies included two randomized control trials, one randomized control trial with a prospective pretest-posttest experimental design, one cross-sectional descriptive design, and a population-based, prospective cohort design. These five articles were found through PubMed, Google Scholar, and the ETSU library database. Findings: Exercise interventions are beneficial to reduce postpartum depression symptoms. Nurses specifically can utilize this data to assist women with postpartum depression symptoms and provide better education throughout pregnancy and early postpartum to help prevent postpartum depressive symptoms. Conclusions: Future research is suggested to focus on the mode, frequency, intensity, and duration to describe the volume of physical activity in a given time frame that is needed to affect postpartum depression. Keywords: exercise, postpartum depression, nursing

Background: The mood stabilizer lithium has long been reported to be associated with reduced suicide risks, but many studies reporting associations between lithium and reduced suicide risks also have been nonrandomized and lacked adjustment for many potential confounders, active controls, uniform follow-up, or intent-to-treat samples. Concerns also have been raised that medications being considered as potential suicide preventative might increase risks of nonsuicide mortality while reducing risks of suicide. Methods: Three studies of Veterans Health Administration (VHA) patients were conducted combining high-dimensional propensity score matching with intent-to-treat analyses to examine the associations between lithium and valproate and one-year suicide and nonsuicide mortality outcomes. Results: In intention-to-treat analyses, initiation of lithium, compared to valproate, was associated with increased suicide mortality over 0-365 days among patients with bipolar disorder (Hazard Ratio (HR) 1.50 [95% Confidence Interval 1.05, 2.15]) Nonsuicide mortality among VHA patients with or without bipolar disorder was not significantly associated with the initiation of lithium compared to valproate ( HR 0.92 [0.82-1.04]). Rates of treatment discontinuation, however, were very high (≈ 92%). Longitudinal analyses revealed that the increased suicide risks associated with initiating lithium among patients with bipolar disorder occurred exclusively after discontinuation of lithium vii treatment. In secondary analyses restricted to patients still receiving their initial treatment, there was no difference in suicide risk between the initiation of lithium or valproate. Conclusions: Significantly increased risks of suicide were observed at one year among VHA patients with bipolar disorder initiating lithium compared to valproate, related to risks observed after the discontinuation of lithium treatment Since these studies are nonrandomized, confounding may account for some or all of our findings, including the risks observed after lithium discontinuation. Nevertheless, these results suggest that health systems and providers consider steps to minimize any potential lithium discontinuation-associated risk. Approaches might include educating patients about possible risks associated with discontinuation and closely monitoring patients after discontinuation if feasible. Given the obvious importance of any substantive difference between lithium and valproate in suicide or nonsuicide mortality risk, our studies also suggest that further research is needed, especially research that can further minimize the potential for confounding.

Lung cancer is the leading cause of cancer-related mortality worldwide. The main risk factor associated with lung cancer is cigarette smoking. Research through the years suggests that nicotine in cigarettes promotes lung cancer by activating signaling pathways that lead to cell proliferation, cell survival, angiogenesis, and metastasis. Nicotine’s cellular actions are mediated by its cognate receptors, nicotinic acetylcholine receptors (nAChRs). Here, I describe the expression levels of all known human nAChR subunit genes in both normal and lung cancer cells. Of note, the genes encoding the α5, α3, and β4 subunits (CHRNA5/A3/B4) are over-expressed in small cell lung carcinoma (SCLC), the most aggressive form of lung cancer. This over-expression is regulated by ASCL1, a transcription factor important in normal lung development and lung carcinogenesis. The CHRNA5/A3/B4 locus has recently been the focus of a series of genetic studies showing that polymorphisms in this region confer risk for both nicotine dependence and lung cancer. I show that CHRNA5/A3/B4 depletion results in decreased SCLC cell viability. Furthermore, while nicotine promotes SCLC cell viability and tumor growth, blockade of α3β4 nAChRs inhibits SCLC cell viability. These results suggest that increased expression and function of nAChRs, specifically the α3β4α5 subtype, potentiate the effects of nicotine in SCLC. This dual hit from the carcinogens in tobacco and the cancer-promoting effects of nicotine, may provide a possible mechanism for the increased aggressiveness of SCLC. In addition, nAChRs can be activated by the endogenous ligand, acetylcholine, which acts as an autocrine/paracrine growth factor in SCLC. Increased function of α3β4α5 nAChRs in SCLC could also potentiate acetylcholine’s mitogenic effects. This mechanism, combined with other known autocrine/paracrine growth loops in SCLC, may help explain the ineffectiveness of available therapies against SCLC. In an effort to add to the current arsenal against SCLC, I screened a 1280-compund library using a bioluminescence-based viability assay I developed for high-throughput applications. Primary screening, followed by secondary and tertiary verification, indicate that pharmacologically active compounds targeting neuroendocrine markers inhibit SCLC cell viability.

BACKGROUND: Of the 22 known measures of nicotine dependence (ND), none capture the overall disease severity of physical dependence alone. Instead, they capture constructs related to dependence, such as perceived risk, psychological addiction, smoker motivations, or smoking related behaviors, but none of the measures include only physical withdrawal symptoms to capture physical dependence on nicotine. AIM: To develop a range of nicotine dependence measures that capture physical dependence on nicotine. METHODS: The final measures were developed in a cross-sectional study conducted in three phases: 1) candidate item development through literature review and cognitive interviews, 2) developing and pre-testing the survey, and 3) survey administration and psychometric evaluation to validate three distinct measures. The final survey was conducted at four health clinics and three high schools. Psychometric tests used to select the final measure items included inter-item correlations, sensitivity analyses done by subgroup, item-total correlations, convergent validity tests, and confirmatory factor analysis. The final measures were evaluated using confirmatory factor analysis (CFA), internal reliability, total score distributions, and convergent validity correlations. Relative validity analyses were also conducted using a ratio of F-Statistics to compare the ability of each new measure to differentiate dependent smokers as compared previous measures. RESULTS: The final sample included 275 smokers ranging from 14 to 76 years old (mean=30.9, SD=16.2), who smoked an average of 11.5 cigarettes per day (range=0-50, SD=9.4). The sample was 86.5% white and 57.5% male. The three new measures developed included: 1) the 4-item Withdrawal-Induced Craving Scale (WICS) used to capture severity of craving, the most common physical withdrawal symptom; 2) the 12- item Nicotine Withdrawal Symptom Checklist (NWSC), which measures both overall disease severity and the severity of a comprehensive list of individual physical withdrawal symptoms including withdrawal-induced craving, anger, anxiety, depression, headache, insomnia, loss of focus, restlessness, and stress; and 3) the 6-item brief NWSC (NWSC-b), a short measure which only captures overall disease severity. All of the new measures exhibited a unidimensional factor structure loading highly on a single factor (thought to be physical dependence). They also correlated highly (over 0.6) and significantly (p<0.001) to a battery of convergent validity indices including four widely used nicotine dependence measures: Hooked on Nicotine Checklist (HONC), the Autonomy Over Tobacco Scale (AUTOS), the Fagerström Test for Nicotine Dependence (FTND), and self-rated addiction. CONCLUSION: The WICS, NWSC, and NWSC-b provide three distinct validated tools that can be used by researchers, clinicians, and educators to track the progression of physical dependence on nicotine across a range of smoking behaviors and histories.

Depression is a common comorbidity in rheumatoid arthritis (RA), yet it may not be adequately recognized during routine clinical care. RA symptoms may confer a risk for depression, and vice versa; depression may affect RA disease activity and response to treatment. The study aims were to compare patient- and physician-reported depression measures, evaluate the temporal bi-directional association between RA disease activity and depressive symptomology, and assess depression as a moderator of RA treatment. Patients were identified using a national RA registry sample (Consortium of Rheumatology Researchers of North America; CORRONA). Depression prevalence and incidence rates were estimated, and concordance and disagreement using measures reported separately by patients and physicians, as well as baseline cross-sectional associations between RA disease and a history of depression. A survival analysis was conducted to temporally predict the incident onset of self-reported depressive symptoms using the different metrics of RA disease activity. Also, mixed effects models were used to assess prospective changes in RA disease activity by prevalent and incident depressive symptom status. Lastly, logistic regression models compared the likelihood of clinical response to RA treatment during follow-up in those with and without depression when starting biologic disease modifying anti-rheumatic drug (DMARD) therapy. Patient-reported depression rates were much higher and significantly different from physician based comorbidity estimates. Patient and physician RA disease activity measures were associated with an increased risk for depression onset, but not laboratory-reported serum biomarkers. Similarly, depression was temporally associated with significantly slower rates of decline regarding every patient-reported disease activity measure, some physician-reported metrics, but not acute phase reactants. Moreover, there was a significantly lower probability of achieving clinical remission among those with depression on a biologic DMARD after 6 months and an analogous effect at 12-months that was slightly lower in magnitude, which did not reach statistical significance. Rheumatologists under-reported the occurrence of prevalent and incident depressive symptoms, and thus are likely unaware of its presence in their RA patients. Further, the results suggest the bi-directional effects between these conditions are related to the cognitive and behavioral aspects of depression and their interactions with disease activity, rather than shared immunological mechanisms in the context of cell-mediated immunity. When also considering the impact on clinical response to biologic DMARDS, the findings collectively imply that rheumatologists must address any challenges due to depression to provide the best care to their patients.

Attention Deficit/Hyperactivity Disorder (ADHD) is a common psychiatric disorder of childhood that is characterized by symptoms of inattention, impulsivity/hyperactivity, or a combination of both. Intrinsic brain dysfunction in ADHD can be examined through various methods including resting state functional Magnetic Resonance Imaging (rs-fMRI), which investigates patients’ functional brain connections in the absence of an explicit task. To date, studies of group differences in resting brain connectivity between patients with ADHD and typically developing controls (TDCs) have revealed reduced connectivity within the Default Mode Network (DMN), a resting state network implicated in introspection, mind-wandering, and day-dreaming. However, few studies have addressed the use of resting state connectivity measures as a diagnostic aide for ADHD on the individual patient level. In the current work, we attempted first to characterize the differences in resting state networks, including the DMN and three attention networks (the salience network, the left executive network, and the right executive network), between a group of youth with ADHD and a group of TDCs matched for age, IQ, gender, and handedness. Significant over- and under-connections were found in the ADHD group in all of these networks compared with TDCs. We then attempted to use a support vector machine (SVM) based on the information extracted from resting state network connectivity to classify participants as “ADHD” or “TDC.” The IFGmiddle temporal network (66.8% accuracy), the parietal association network (86.6% specificity and 48.5% PPV), and a physiological noise component (sensitivity 39.7% and NPV 69.6%) performed the best classifications. Finally, we attempted to combine and utilize information from all the resting state networks that we identified to improve classification accuracy. Contrary to our hypothesis, classification accuracy decreased to 54-55% when this information was combined. Overall, the work presented here supports the theory that the ADHD brain is differently connected at rest than that of TDCs, and that this information may be useful for developing a diagnostic aid. However, because ADHD is such a heterogeneous disorder, each ADHD patient’s underlying brain deficits may be unique making it difficult to determine what connectivity information is diagnostically useful.

Recent studies have shown elevated neuroinflammation in a large subset of individuals diagnosed with schizophrenia. A pro-inflammatory cytokine, tumor necrosis factor-alpha (TNFα), has been directly linked to this neuroinflammation. This study examined the effects of two TNFα modulators (PD2024 and PD340) produced by our collaborators at P2D Bioscience, Inc., to alleviate auditory sensorimotor gating deficits and reduce microglial cell activation present in the polyinosinic:polycytidylic (Poly I:C) rodent model of schizophrenia. Auditory sensorimotor gating was assessed using prepulse inhibition and microglial activation was examined and quantified using immunohistochemistry and confocal microscopy, respectively. Both PD2024 and PD340 alleviated auditory sensorimotor gating deficits and reduced microglia activation and thereby demonstrated the ability to treat both the behavioral and neuroinflammatory aspects of the disorder. These results are significant and suggest that neural TNFα is a potential pharmacological target for the treatment of schizophrenia.

CONTEXTE : Les critères de jugement prenant en compte le ressenti des patients, tels que la qualité de vie, deviennent des éléments déterminants pour l’évaluation des prises en charge et l’aide à la décision. Bien que les troubles mentaux représentent un fardeau considérable tant en termes de prévalence que de conséquences économiques, les connaissances sur la qualité de vie des patients pris en charge par les services de psychiatrie sont limitées, ce qui complexifie la prise de décisions éclairées dans le champ de la santé mentale.OBJECTIFS : Nos objectifs étaient d’évaluer la qualité de vie, mesurée par des scores d’utilité, des patients souffrant de troubles mentaux en France, de mesurer la perte de qualité de vie attribuable à ces troubles et d’identifier les facteurs qui y sont associés.MATERIEL ET METHODES : Après une revue de la littérature décrivant les instruments de mesure de la qualité de vie utilisés en santé mentale, nous avons évalué la qualité de vie des patients pris en charge par le secteur de psychiatrie générale en mobilisant deux instruments permettant le calcul de scores d’utilité : le SF-36, permettant le calcul de scores d’utilité via le SF-6D, et l’EQ-5D. Nous avons comparé leurs performances et avons évalué leur concordance. Nous avons confronté la qualité de vie des patients souffrant de troubles mentaux à celle de la population générale en mobilisant les données du volet « ménages » de l’enquête Handicap-Santé. Enfin, nous avons recouru à des outils de modélisation adaptés aux spécificités des distributions des scores d’utilité pour étudier les caractéristiques sociodémographiques, cliniques et les prises en charge psychiatriques des patients qui y sont associées.RESULTATS : Notre enquête a inclus 212 patients. Leurs scores d’utilité moyens s’élevaient à 0,684 dans le cas d’une mesure par le SF-6D et à 0,624 dans le cas de l’EQ-5D et étaient inférieurs de 11% à ceux de la population générale. Le fait d’être une femme et le fait d’être sévèrement malade étaient associés à des scores d’utilité plus faibles. Les patients ayant été librement hospitalisés à temps plein, par rapport à ceux ne l’ayant pas été, avaient tendance à avoir des scores SF-6D plus faibles tandis que les patients pris en charge à temps partiel présentaient des scores SF-6D plus élevés. Les scores d’utilité SF-6D et EQ-5D n’étaient pas concordants. Si les deux instruments étaient comparables en termes d’acceptabilité et de validité discriminante et convergente, l’EQ-5D était moins sensible, présentant un effet plafond, et les modèles mis en œuvre pour identifier les facteurs associés à ce score présentaient des performances modestes.CONCLUSION : Nos travaux ont permis d’objectiver l’impact négatif des troubles mentaux sur la qualité de vie des personnes atteintes. Les différences importantes identifiées entre les scores d’utilité SF-6D et EQ-5D font du choix de l’instrument le plus adapté un enjeu majeur. Le manque de sensibilité du score d’utilité EQ-5D et les difficultés rencontrées pour trouver un modèle statistique adapté aux spécificités de ce score suggèrent une meilleure adéquation du SF-6D au champ de la santé mentale. Cependant, des travaux menés sur des échantillons de taille plus conséquente seront mis en œuvre pour préciser nos résultats. / BACKGROUND: Assessment criteria which take patients’ perceptions into account, such as quality of life, are becoming increasingly important in health services assessment and policy and clinical decision-making. Despite the fact that mental disorders represent a significant burden in terms of prevalence and economic consequences, there is a lack of knowledge regarding quality of life of patients cared for by mental health care services which impedes informed decision-making in the field of psychiatry.OBJECTIVES: Our objectives were to measure quality of life using utility scores of people cared for by mental health care services in France; to assess the loss of quality of life attributable to mental disorders; and to identify factors associated with quality of life.MATERIAL AND METHODS: After a literature review describing quality of life tools used in the field of mental health, we undertook a survey to measure the quality of life of people suffering from mental disorders who were treated in the general psychiatric sector using two tools and the corresponding utility scores: the SF-36, allowing calculation of utility scores by the SF-6D, and the EQ-5D. We compared them in terms of performance, and we assessed their consistency. We evaluated the quality of life loss attributable to mental disorders considering data from the French general population-based survey on health and disabilities as a reference. Finally, we used several models adapted to the specificities of the utility score distributions to identify socio-demographic, clinical and mental health care utilization characteristics associated with quality of life.RESULTS: 212 patients were included. The mean utility score was 0.684 when assessed by the SF-6D, and 0.624 when assessed by the EQ-5D. Utility scores of patients suffering from mental disorders were 11% lower than those of the general population. Being a woman and being severely ill were factors associated with lower utility scores using both tools. In comparison with no hospitalization, voluntary hospitalization within the past 12 months was associated with lower SF-6D utility scores, whereas part-time hospitalization was linked with higher SF-6D utility scores. SF-6D and EQ-5D utility scores showed poor agreement in measuring quality of life. These instruments were similar in terms of acceptability as well as discriminant and convergent validity; however, the EQ-5D showed lower sensitivity, illustrated by a ceiling effect, and the models used to study factors associated with this score showed poor performances.CONCLUSION: We objectivized the negative impact of mental disorders on quality of life. Considering the significant differences identified between the SF-6D and EQ-5D utility scores, the choice of the most adapted instrument constitutes a major issue. The lack of sensitivity of the EQ-5D and the difficulties experienced in finding a model adapted to the specificities of this score would suggest that the SF-6D is better suited to the field of mental health. However, our results must be confirmed by analysis on larger samples.

The aim of this phenomenological qualitative study was to capture and understand the essence of the lived experiences of individuals after participating in equine facilitated psychotherapy (EFP). In that the experiences of participants after exposure to EFP have not previously been examined, this study adds to the literature on this innovative therapy. Theoretical viewpoints on animal assisted therapy and solution-focused brief therapy (SFBT) were explored, as well as how the SFBT methodology compares to techniques used in EFP. Using interviews, the study involved capturing participants' experiences by collecting their descriptions of their involvement with EFP, identifying the specific experiences they noted, ascertaining what the participants did with these experiences, and discerning themes or patterns in the interview data. A purposive sample of 10 adults who had participated in EFP participated in interviews, the data from which were analyzed by hand coding. Analysis showed improved quality of life with improvements in overall well-being and in participants' relationships. The findings of this research study may lead to additional research in this area and may promote the establishment of consistent techniques in EFP, proper credentialing of those who use EFP, and applicable regulatory standards. By exploring the lived experiences of individuals who have participated in EFP, providers may be able to delve more deeply into the curative factors that may be at work with this type of therapy.

Introducción: En los últimos años, se ha informado de una variación climática importante que puede generar un impacto en la salud mental. Esta variación genera distintos eventos climáticos que tienden a aumentar el estrés en pacientes con trastornos mentales y desencadenarlo en personas que aún no están enfermas. Objetivo: El objetivo del estudio fue describir y relacionar la temperatura máxima y mínima, humedad relativa media y precipitación máxima con el número de atenciones por trastornos mentales en consulta externa en las redes de salud de las regiones de la costa desde 2002 hasta el 2018 en el Perú. Métodos: Se realizó un estudio ecológico exploratorio, donde la unidad de análisis fue red de salud – mes. El número de atenciones en consulta externa y las variables meteorológicas fueron reportadas por medianas y rangos intercuartílicos. Para el análisis bivariado y multivariado, se utilizó el coeficiente de Spearman y la regresión de Poisson, respectivamente. Resultados: La proporción del número de atenciones por las categorías F00-F09, F10-F19, F30-F39 y F40-48 aumentó a una mayor temperatura máxima y precipitación máxima. Las categorías F20-29, F30-39, F40-48 y F60-F69 mostraron un aumento en sus atenciones cuando incrementó la humedad. Conclusión: Se encontró relación entre una mayor temperatura máxima, humedad y precipitación máxima, y el incremento de la proporción del número de atenciones por trastorno mental en consulta externa. Es necesario realizar investigaciones que evalúen el efecto de las variaciones climáticas sobre los trastornos mentales para implementar estrategias de salud que permitan abordar la carga de la enfermedad. / Introduction: In recent years, significant climate variation has been reported can have an impact on mental health. This variation generates different climatic events that require increasing stress in patients with mental disorders and trigger it in people who are not yet sick. Objective: The aim of the study was to describe and relate the maximum and minimum temperature, average relative humidity and maximum precipitation with the number of attentions for mental disorders in outpatient care in the health networks of the coastal regions from 2002 to 2018 in Peru. Methods: An exploratory ecological study was conducted, where the unit of analysis was health network - month. The number of outpatient visits and meteorological variables were reported by medians and interquartile ranges. For bivariate and multivariate analysis, Spearman coefficient and Poisson regression were used, respectively. Results: The proportion of the number of attentions by categories F00-F09, F10-F19, F30-F39 and F40-48 increased at a higher maximum temperature and maximum precipitation. The categories F20-29, F30-39, F40-48 and F60-F69 showed an increase in their attentions when humidity increased. Conclusion: A relationship was found between a higher maximum temperature, humidity and maximum precipitation, and an increase in the proportion of the number of attentions for mental disorder in outpatient care. Research assessing the effect of climate variations on mental disorders is needed to implement health strategies that will address the burden of disease. / Tesis