María Yoldi-Negrete

Background: Sunlight has profound impacts on physical and mental health, beyond vision, including effects on circadian rhythms, alertness, mood, and sleep. A family history of any mood disorders is strongly associated with psychiatric disorders including bipolar disorder. The purpose of this study was to evaluate the association between a family history of any mood disorder in patients with bipolar I disorder and solar insolation at varied international onset locations. Methods: Data for this analysis were available from 5842 patients with a diagnosis of bipolar I disorder obtained at 83 collection sites in both hemispheres. This included 4752 patients from 71 collection sites in the northern hemisphere and 1090 patients from 12 collection sites in the southern hemisphere. Patient data variables were obtained from records or interviews. Solar insolation data were obtained from The National Aeronautics and Space Administration (NASA) Power database for each onset location, and the ratio of the mean monthly minimum/mean monthly maximum solar insolation was calculated. Typically, the ratio is largest near the equator (little yearly change in solar insolation) and smallest near the poles (large yearly change in solar insolation). Results: A significant relationship was found between a family history of any mood disorder, the ratio of the mean monthly minimum/mean monthly maximum solar insolation, and gender. The odds of a family history of mood disorder increased as patient location nears the poles and decreased near the equator. Female gender also increased the odds of having a family history of a mood disorder. Conclusions: This study highlighted the association between family history, solar insolation, and gender in international patients with bipolar I disorder. Given the profound effects of sunlight on human health, the family of patients with bipolar disorder who live in the same location with the same solar insolation, and especially females, may be at increased risk for a mood disorder.

Introduction: Anesthesiology residents play a crucial role in healthcare, yet the demanding nature of their residency—long hours, high stress, and challenging work conditions—often leads to mental health issues like depression and anxiety. Despite the importance of resident well‐being, mental health problems among anesthesiology residents in Mexico remain underexplored. The main objective of this study was to characterize potential profiles linked to anxiety, depression, and their comorbidity among anesthesiology residents, drawing on demographic and residency‐related variables. Materials and Methods: A cross‐sectional study was conducted with 1208 anesthesiology residents who completed an online survey between October 2019 and April 2021. The survey collected demographic data, professional activities, adversities, and mental health, using the ICD‐11 PHC screening test. Results: A total of 74.5% of residents suffered from no symptoms of depression or anxiety (C), 5.3% suffered from depression (D), 13.1% suffered from anxiety (A), and 7.1% suffered from both (AD). Sleep deprivation (average of 5.1 h per night) was common, with residents reporting more sleep disturbances and work‐related distress, particularly those suffering from depression or comorbid depression and anxiety. Logistic regression showed that depression was associated with being single and sleeping fewer hours, while residents with anxiety or both conditions reported higher work‐related distress and greater exposure to assaults. Discussion: This study emphasized the need for systemic changes aimed at a more supportive training environment, including interventions to protect residents’ sleep, which will enhance well‐being and provide mental health care to those who need it.

Background: Borderline Personality Disorder (BPD) may include rigid thoughts, interpersonal difficulties, unstable identity, and the presentation of intense and volatile emotions; the leading indicator for this condition is symptom severity (SS). Within this spectrum, there could be subjective cognitive complaints (SCC) that may worsen the severity of the clinical condition. The present study aimed to compare SCC scores between BPD participants and a group of control subjects (CS) and to determine the association between BPD symptom severity and SCC in participants with BPD. Methods: 102 participants with BPD and 73 CS participants from Ramon de la Fuente Muñiz National Institute of Psychiaty were included. In order to measure symptom severity, participants responded to the Borderline Evaluation of Severity Over Time (BEST) scale, and for SCC through the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Results: COBRA total scores were higher in participants with BPD (26.9 ± 9.3) compared to CS (12.9 ± 6.8; t = –10.8, p < 0.001). Positive correlations resulted between the COBRA total score and the BEST dimensions of thoughts and feelings (r = 0.38, p < 0.001), Negative behaviors (r = 0.30, p < 0.002), and the Total BEST score (r = 0.38, p < 0.001). Conclusion: Participants of this study experience high levels of SS, which includes the constant presence of harmful and intrusive thoughts and feelings, as well as dysfunctional behaviors. This clinical context correlates positively with a high report of SCC, thus highlighting the importance of evaluating SCC as a relevant factor of patients' clinical experience and considering it within their personal needs to improve the course and prognosis throughout their treatment.

Background: Borderline personality disorder (BPD) has a high prevalence, presenting with self-injurious behaviors, suicide attempts and other psychiatric comorbidities. This condition is accompanied by high levels of stigma and self-stigma, driving to deleterious effects on prognosis. The present study aimed to compare demographic and clinical characteristics of women diagnosed with BPD with low and high internalized stigma and to address internalized stigma dimensions severity (disclosure, positive aspects, and discrimination) between the source of perceived stigma. Methods: A total of 106 women with a diagnosis of BPD were evaluated for sociodemographic data, sources of stigma, the severity of the symptomatology and internalized stigma, evaluated with the Borderline Evaluation of Severity Over Time (BEST) and the Spanish version of King's Internalized Stigma Scale (ISS), respectively. Results: Participants with high internalized stigma reported greater symptom severity. Regarding the reported sources of stigma, in almost all sources of stigma, discrimination was perceived as greater (p < 0.05) (friends, co-workers, doctors, psychiatrists and nurses) as well as the perceived global internalized stigma (p < 0.05) for friends, co-workers and nursing staff. Conclusion: It is necessary to address stigmatizing behaviors by health personnel and the support network close to the patient in addition to improving awareness about associated internalized stigma which is related to worse outcomes.

Purpose: Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically evaluated in studies on cognition in BD. Our aim was to determine if attention and/or inhibition of cognitive interference in euthymic patients with type I Bipolar Disorder (BD-I) is affected by symptoms of anxiety. Patients and Methods: Eighty-seven euthymic BD-I patients were included. Patients with comorbidities other than Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) were excluded. State anxiety was measured with the Brief Inventory of Anxious Responses and Situations (ISRA-B). Subjective cognitive performance was evaluated with the COBRA scale, attention with the Digit-Span Forward task and inhibition of cognitive interference was assessed with the StroopTest interference score. Multiple linear regression models were used to test if anxious symptoms were associated with attention or inhibition of cognitive interference, considering other known contributors for cognitive impairment. Results: Attention was unaffected by anxiety symptoms, but the overall regression for inhibition of cognitive interference was significant: years of schooling (β=1.12, p = 0.001), cognitive complaints (β=0.44, p = 0.008), and anxiety (β=− 0.21, p = 0.017) explained 15% of the interference score of the Stroop test (R2 = 0.15). Conclusion: Beyond residual affective symptoms, anxious symptoms seem to affect inhibition of cognitive interference. We recommend routine testing of anxiety when considering cognitive evaluations, especially when screening for cognitive deficits.

Cognitive deficits play an important role in Bipolar Disorder (BPD). The Cognitive Problems and Strategies Assessment (CPSA) is a measure that evaluates the patient’s perception of cognitive difficulties, and the spontaneous use of compensatory strategies and could thus have potential utility for clinical practice in patients with BPD. Our aim was to determine the validity and reliability of the Cognitive Problems and Strategies Assessment (CPSA) in Bipolar Disorder (BPD). Ninety-three BPD outpatients and 90 controls completed the Assessment of Problems with Thinking and Memory (APTM) questionnaire and the Assessment of Memory and Thinking Strategies (AMTS) questionnaire which constitute the CPSA, the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), as a measure of convergent validity, and general sociodemographic data. Cronbach’s alpha coefficient, Spearman’s correlation coefficient and independent sample t tests were used for Internal consistency, Convergent validity and Discriminant validity. The APTM had a Cronbach’s alpha coefficient of 0.93 and the AMTS 0.90. The COBRA score and the APTM were significantly correlated. BPD patients exhibited higher scores on the APTM and lower scores on the AMTS than controls. The present instrument enriches the clinician’s repertoire for rapid and inexpensive cognitive evaluation in BPD.

Objective: Examining orthopedic residents in Mexico, researchers explore the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died. Methods: This was a cross-sectional online survey of 642 orthopedic residents from October 2019 to April 2021. Results: Of orthopedic residents contacted, 50.6% responded rate (70.9% male, average age 29.8 years). A total of 12.5% reported significant depressive symptoms and 18.4% reported significant anxious symptoms. On a scale from 0-100, the mean score of perceived work-related distress was 51.9. One-third (33.6%) reported being involved in the care of patient(s) who had died. Higher levels of work-related distress and higher scores on perfectionism were associated with depressive and anxiety symptoms. In particular, being involved in the care of patient(s) who had died was associated with anxious symptoms (OR = 1.79; 95%CI = 1.18-2.72). Conclusions: These results highlight the need for systematic monitoring of the mental health of orthopedic residents in Mexico, particularly those who report a high level of work-related distress or perfectionism or who have recently experienced the death of a patient.

Background: The concept of environmental enrichment (EE) encompasses complex physical, social, cognitive, motor, and somatosensory stimuli to which individuals are differentially exposed. An indicator of EE comprising these elements would facilitate the study of the impact of EE in diverse clinical settings by allowing an easy and comparable measurement. This study aimed to create and test such an EE indicator based on the Florida Cognitive Activities Scale (FCAS), the Multidimensional Social Integration in Later Life Scale (SILLS), and the International Physical Activity Questionnaire (IPAQ). Methods: Participants with major depression and control subjects were recruited in this cross-sectional comparative study. Depressive symptom severity was assessed with the Hamilton Depression Rating Scale (HAM-D). The EE indicator was used to evaluate cognitive, social, and physical activity. We divided the sample into three levels of cognitive and social activities to construct an EE indicator and compared the obtained scores between participants with major depression and control subjects. Results: 40 patients suffering from major depression and 50 control subjects were included. Higher HAM-D scores were associated with lower EE levels. Cognitive and social items exhibited adequate reliability. Control subjects reported higher scores in all three activities evaluated, except for some items of physical activities. This indicator of EE clearly differentiated between participants with major depression from control subjects. Conclusions: FCAS, SILLS, and IPAQ used together are valid to evaluate EE. This EE indicator may be a useful tool during clinical practice. The cross-sectional design and the small sample size are limitations of the present study.

Introduction: Early‐stage predictors of illness course are needed in bipolar disorder (BD). Differences among patients with a first depressive versus maniac/hypomanic episode have been stated, although in most studies, memory bias and time from onset to start of specialized treatment might interfere. The aim was to compare the first 10 years of illness course according to polarity at onset.Methods: 49 type I BD patients admitted for treatment for a first‐time affective episode and a following 10‐year attendance to the institution were included. A retrospective year by year comparison according to polarity at onset (depressive (DPO) or maniac (MPO)) was performed. Cramer's V and Cohen d were computed to determine effect size.Results: 59.2% (n = 29) started with MPO. Both groups were similar in demographic and social outcome characteristics, clinical features, and treatment variables. Patients with DPO reported more depressive episodes than MPO patients (U = 149.0 p < .001, Cohen's d = 0.87); both groups had a similar number of manic episodes. Only during the first year of follow‐up, suicide attempts (SA) were more frequent in patients with DPO while the presence of a psychotic episode and psychiatric hospitalizations were more frequent in the MPO group.Conclusion: According to these findings, it can be concluded that illness onset is only indicative of depressive predominant polarity but is not related to other poor prognostic variables after the first year of illness onset, in treated BD. SA in the first year of an affective disorder could represent a marker of BD.