Vol 4-4 Review Article

Careful Prescribing of Benzodiazepines during COVID-19 Pandemic: A Review

Ruchita Agrawal1,2*

1Seven Counties Services, Louisville KY, USA (Formerly, Centerstone)

2Department of Psychiatry, University of Louisville, Louisville KY, USA

Benzodiazepines have been commonly prescribed for the treatment of anxiety and insomnia in the last few decades. There has been a rising concern regarding safety of benzodiazepines due to overdose related deaths, addictions, and cognitive side effects. COVID- 19 pandemic is expected to cause a mental health crisis. Several studies have shown an increase in anxiety and insomnia. This could mean that prescriptions of benzodiazepine could increase due to increase in anxiety and insomnia. We caution health care providers to use best practices and treat patients with psychotherapy as the first line of treatment and not pharmacotherapy. Prescription Drug Monitoring programs (PDMPs) were started due to this concern of overdose deaths, diversion related to opioids and benzodiazepines. PDMPs are mandatory in most states in the United States of America now.We recommend all health care providers to look at their benzodiazepine prescribing practice, monitor PDMP data and make policies to implement changes in order to avoid the next crisis of benzodiazepines after opioids.

DOI: 10.29245/2578-2959/2020/4.1214 View / Download Pdf
Vol 4-4 Original Research Article

Health-Related Quality Of Life and Rearing Behavior on Migrant Children: A Before-and-After Study

Haiyan XING1*, Wei YU2#

1Department of Nursing, School of Medicine, Shaoxing University, Zhejiang Province, China

2Institute of Epidemiology, Shaoxing Keqiao District Center for Disease Control and Prevention, Zhejiang Province, China

The purpose of this study is to examine the change of Health-related quality of life (HRQOL) and rearing behavior among migrant children as well as their correlations in the city of Shaoxing, China. By cluster sampling, 149 migrant children had completed the questionnaires in 2014 and 2015. Spearman’s correlation was performed to clarify the relationship between change of HRQOL and rearing behavior in migrant children. Multiple linear stepwise regression analytical methods were used to identify the variables that were associated with change of HRQOL. The results showed that total score, physical health, psychosocial health, emotional functional and social functional of HRQOL among migrant children had increased and overprotection of parents was declined. There were negative correlation between change of quality of life (total score) and change of parents rejection or mother overprotection. There were also negative correlation between change of psychosocial health and change of parents rejection and overprotection. The change of quality of life was mostly reflected by change of mother rejection. These data show that HRQOL and negative rearing behavior among migrant children had improved. The change of quality of life was most affected by the negative rearing behavior of parents, especially mothers.

DOI: 10.29245/2578-2959/2020/4.1215 View / Download Pdf
Vol 4-4 Original Research Article

Prefrontal Cortex Response to Threat: Race by Age Variation in 9-10 Year Old Children

Shervin Assari1,2*, Golnoush Akhlaghipour3, Mohammed Saqib4, Shanika Boyce5, Mohsen Bazargan1

1Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

2Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

3Department of Neurology, UCLA, Los Angeles, CA, USA

4Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA

5Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

Background: Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities’ Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children.

Purpose: Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children.

Methods: This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates.

Results: We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces.

Conclusions: For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children’s behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

DOI: 10.29245/2578-2959/2020/4.1209 View / Download Pdf
Vol 4-4 Original Research Article

Mothers’ Global Psychological Health and Sex-specific Expression in Newborns

Stefanie R. Pilkay1*, Terri Combs-Orme2, Frances Tylavsky3, Nicole Bush4, Alicia K. Smith5

1Falk College, School of Social Work, Syracuse University, Syracuse, New York

2College of Social Work, University of Tennessee, Knoxville, Tennessee

3Department of Preventive Medicine, University of Tennesse Health and Science Center, e, Memphis, Tennessee

4Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California

5Department of Gynecology and Obstetrics, Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia

Summary: The prenatal environment can influence gene expression involved in the development, possibly contributing to generational patterns of psychological health. Moreover, sex-specific developmental differences in-utero may result in gene expression differences associated with the prenatal environment. However, it is not clear if maternal overall psychological symptoms will associate with newborn’s gene expression, or if such patterns are consistent between sexes. This study explored the relationships between maternal psychological health (PsyH) and newborn’s gene expression patterns. We assessed PsyH with the Brief Symptom Inventory and newborn gene expression in umbilical cord blood. We conducted combined and sex-stratified analyses of genes expressed in umbilical cord blood.

Findings: PsyH associated with differential expression of 157 genes in males. The 157 differentially expressed genes are more likely to function in metabolic processes. There were no significant differences in gene expression in females.

Application: The sex-specific nature of these findings suggests males may be more vulnerable than females to mothers’ psychological functioning during pregnancy. It is possible that the male-specific results are due in part to female newborns developing under different neuroendocrine conditions. Future research examining prenatal exposures should consider sex differences.

DOI: 10.29245/2578-2959/2020/4.1216 View / Download Pdf
Vol 4-4 Review Article

Young, Alone, and Young Alone During a COVID-19 Lockdown

Tiffany Field1,2*, Shantay Mines2, Samantha Poling2, Miguel Diego1, Debra Bendell2, Connie Veazey2

1University of Miami/Miller School of Medicine, USA

2Fielding Graduate University, USA

The effects of age (young versus old) and living status (alone versus with others) during the COVID-19 lockdown were assessed via a Survey Monkey questionnaire on 260 individuals (18-82 years). Both age and living status and their interaction effects were explored via ANOVAs on scales for health, media use, mood states including anxiety and depression, posttraumatic stress symptoms, fatigue and sleep disturbances. ANOVAs were conducted via a median split on age as well as on a group comparison of young (20-40 years) versus old (60-80 years) individuals. The results of these two types of data analyses were consistent on most variables, suggesting that the young versus the old experienced more stress, anxiety, depression, and PTSD symptoms as well as greater fatigue and sleep disturbances. And, they reported fewer health activities. Significant effects were also noted for the alone versus living with others’ groups including less engagement in exercise and work at home by the alone individuals as well as more stress, depression, fatigue, and PTSD symptoms. A significant age by living condition interaction effect suggested that the young living alone had the highest depression scores. The experiences that were common to the young, the living alone, and the young living alone were being lonely, depressed and fatigued. These results highlight the importance of prevention/intervention for the young, the alone and the young alone during lockdowns like COVID-19.

DOI: 10.29245/2578-2959/2020/4.1219 View / Download Pdf
Vol 4-4 Original Research Article

Real-world Evaluation of a Novel Technology-enabled Capnometry-assisted Breathing Therapy for Panic Disorder

Divya K. Madhusudhan1, Kore N. Glied1, Eugene Nguyen1, Jennifer Rose1, Dena M. Bravata1,2*


1Crossover Health, San Clemente, CA

2Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

Introduction: Anxiety disorders which include generalized anxiety disorder, panic disorder (PD), post-traumatic stress disorder, and obsessive-compulsive disorder are common psychiatric condition associated with significant social, occupational, physical, and economic costs. Interventions that target the respiratory dysregulation associated with anxiety disorders have demonstrated considerable therapeutic benefit. However, no such intervention has been evaluated in among PD patients receiving care in an employer-sponsored health center.

Objective: To evaluate the use of a novel, capnometry-assisted breathing therapy on clinical outcomes, engagement, and satisfaction for patients with PD receiving care in an employer-sponsored health center.

Methods: Prospective analysis of participants using the program between 1/1/2018 and 06/30/2020.

Results: Twenty-two participants enrolled. Their average weekly usage remained high throughout the 4-week treatment protocol of 17 minutes twice a day for 28 days (11.6 sessions (SD 3.1) in week one and 10.4 sessions (SD 4.0) in week four). Their average Panic Disorder Severity Scale score decreased from 13.3 (SD ± 3.6) to 5.6 (SD ± 1.8), indicating that panic severity decreased from “moderately ill” to “slightly ill.” Use of the program was associated with clinically and statistically significant improvements in respiratory markers: average respiratory rate decreased from 14.9 (SD 3.6) to 11.9 (SD 4.7) breaths per minute (p<0.001) and end-tidal pCO2 increased from 37.2 mmHg (SD 4.2) to 39.1 mmHg (SD 3.6) (p<0.001). Engagement was associated with decline in utilizations of behavioral health services at employer-sponsored primary care center clinic after the intervention.

Conclusion: The clinical improvements observed in this pilot suggest that capnometry-assisted breathing therapy is a valuable tool for patients suffering from panic-associated symptoms.

DOI: 10.29245/2578-2959/2020/4.1220 View / Download Pdf
Vol 4-4 Review Article

An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period

Sarah Araji1, Ashley Griffin2, Laura Dixon3,4, Shauna-Kay Spencer1, Charlotte Peavie1, Kedra Wallace1,5*


1Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

2Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216 USA

3Department of Psychology, University of Mississippi, Oxford, MS 38677 USA

4Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, 39216 USA

5Department of Neurobiology & Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, 39216 USA

Anxiety during pregnancy is associated with adverse outcomes in mothers and infants. Unfortunately, as anxiety is often synonymously mentioned with depression, the studies focusing solely on anxiety during pregnancy are not as robust as those in the field of depression are. In this work, we provide an overview of what is currently known about general anxiety during pregnancy, pregnancy-related anxiety and the potential impacts anxiety could have on post-partum care. An overview of potential risk factors, post-partum maternal outcomes, infant outcome along with pharmacological and non-pharmacological treatments are covered with a specific focus on high-risk pregnancies. Although anxiety during pregnancy is normative; anxiety can become problematic and negatively impact upon behavior, resulting in potential harm to the mother, as well as her developing fetus or child (ren) at home. The clinical diagnosis for anxiety and conditions associated with anxiety often require lengths of time that are not applicable for the pregnant patient, which has led to diagnosis and terms such as pregnancy-related anxiety. Importantly, increasing awareness about the increased potential risk to mothers who may be affected by anxiety during pregnancy or the post-partum period has the potential to improve maternal mental health screening and access to care.

DOI: 10.29245/2578-2959/2020/4.1221 View / Download Pdf
Vol 4-4 Original Research Article

Sleep Quality in Schizophrenia

Aman Dule1*, Gutema Ahmed2, Worknesh Tessema2, Matiwos Soboka2


1Mettu University, College of health science, Department of psychiatry, Mettu, Ethiopia

2Jimma University, Institute of health science, Faculty of medicine, Department of psychiatry, Jimma, Ethiopia

Purpose: The aim of this study is to assess the quality of sleep and contributing factors in treated patients with schophrenia.

Materials and methods: The sleep quality of 411 subjects in treatment for schizophrenia was assessed. A cross-sectional study design was used to determine mediating factors. A consecutive sampling technique was used for recruitment. The Pittsburgh Sleep Quality Index (PSQI) was used to assess outcome variables, and the positive and negative syndrome scale (PANSS) and the four-item Morisky-Green test (MGT) was used for symptom severity and medication adherence. Logistic regression analysis was used to determine factor association and the adjusted odds ratio (AOR) and a p-value < 0.05 determined statistical significance.

Results: More than half of the patients were poor sleepers. Sleep determinants were: a) urban residence AOR=3.08 [2.57, 8.12], b) family size ≥6 AOR=2.72 [1.38, 5.08], c) current khat use AOR=2.30 [1.22, 4.31], d) low antipsychotics adherence AOR=6.23 [3.61, 10.75], e) positive and negative syndrome scale (PANSS) for positive symptoms greater than mean AOR=2.99 [1.69, 5.30] and PANSS for general symptoms greater than mean AOR=4.22 [2.22, 8.05]. These were all significantly associated with sleep quality on multiple logistic regressions.

Conclusion: There is a high prevalence of poor sleep quality among schizophrenia patients and risk factors are known. It is time to address these factors clinically to ensure better health for this population.

DOI: 10.29245/2578-2959/2020/4.1223 View / Download Pdf