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Adverse childhood experiences (ACEs) before the age of 18 years are pervasive and noteworthy public health concerns. The ACEs are associated with sleep disorders in later life. In this study, we conduct a systematic review to explore the effects of ACEs on sleep in adulthood. Using Medical Subject Headings keywords, we searched Medline, PubMed, PubMed Central, the American Psychological Association PsycArticles, and PsychInfo databases to evaluate the association between ACEs and sleep disturbances. ACEs increase the odds of developing chronic short sleep duration, that is,6 hours of sleep per night compared with optimal sleep duration of 7-9 hours per night during adulthood. The ACEs are positively associated with poor sleep characteristics such as short sleep duration and long-term sleep problems. Clinicians should pay close attention to developmental trauma care, access community health programs, and help develop better coping skills, resiliency, and good sleep habits in their patients.

Even though marijuana is illegal on the federal level, it is one of the most used drugs in the United States during pregnancy. Our study investigates the relationship between numerous socioeconomic, demographic, and mental health risk variables and substance use during pregnancy. We examined data from the National Survey on Drug Use and Health from 2017 to 2019. Compared with the no serious psychological distress (SPD) group, the odds of using cannabis were higher in pregnant women with past-month SPD. In this study, in comparison with unmarried pregnant women, married pregnant women had a 67% lower chance of currently using cannabis. Racially, Hispanic pregnant women had 3 to 4 times higher odds for current use of cannabis as compared with the other races. Preventing cannabis use and its adverse effects by screening pregnant women could be part of the current strategy for reducing cannabis use.

Approximately 17.3 million adults in the United States have had a minimum of one major depressive episode. Comorbidity of depression and pain can affect individuals of any age, but is more prevalent in the elderly affecting up to 13% of people in the elderly population. Given that depression and suicidal ideation (SI) pose a considerable burden resulting in enormous suffering, there is a need to understand the factors of the relationship between chronic pain (CP), depression, and SI.Our primary objective in this study was to compare suicidality (SI/attempt [SA]) between patients with major depressive disorder (MDD) and CP and a matched control group. The secondary objective was to compare length of stay, total hospital costs, and discharge disposition in these populations.The National Inpatient Sample (NIS) dataset developed by the Healthcare Cost and Utilization Project was used for this study. The NIS is a database of hospital inpatient stays derived from billing data submitted by hospitals to statewide data organizations across the United States. We obtained patient records from the NIS dataset for the years 2006 to 2017. All data were de-identified so Institutional Review Board approval was waived.We used mean and standard error to describe continuous data and counts (percentage) to describe categorical data. Categorical data were compared using Rao-Scott adjusted chi-square tests and continuous data were compared using Student's t tests. Matching was performed using propensity scores in random order with a caliper size of 0.001. To assess predictors associated with suicidality, logistic regression analysis was performed.A total of 393,481 patients having MDD with CP (MDD+CP) were included in the analysis. The mean age was 49.4 years, and 54.9% of patients were women. Overall, rate of composite outcome of SI/SA was more prevalent in MDD+CP group (51% vs 41%, P0.001). Rate of SI was 48% vs 39% (P0.001) in the MDD+CP and MDD without CP (MDD-CP) groups, respectively. MDD+CP was one of the strongest predictors of suicidality, responsible for 48% more risk of SI/SA compared to MDD-CP group. In comparison to non-Whites, the rate of suicidality was 7.5% less in White population. Alcohol abuse and substance abuse were associated with 17% and 8% greater risk of SI/SA, respectively. For women, the odds of having SI/SA was 1.20 greater compared to men.No information was available on the causal relationship between MDD+CP disorder and SI/SA. Retrospective studies are susceptible to recognition, reporting, and coding bias. There is no information available on medications use or the duration and severity of CP and bipolar disorder, which can all be confounding factors.Psychiatrists and other physicians must be cognizant of the presence of CP and the risk of suicide, especially when patients present with depressive symptoms. The treatment plan for this patient population should include routine screening for pain symptoms and risk assessment for SI.

Bipolar disorders (BDs) are associated with significant risk of suicide. BD patients (age ≥18 years) admitted to the hospital were identified from the National Inpatient Sample dataset. Based on the secondary diagnosis of chronic pain disorder (CPD), patients were stratified into two groups (1) BD with CPD (BD + CPD) and (2) BD without CPD (BD - CPD). Groups were matched (1:1) for the type of BD and compared for baseline characteristics and suicidal ideation/attempt (SI/SA). Compared with BD - CPD, most patients in the BD + CPD group were older (mean age, 47.6 vs. 40.4 years), female (58.4% vs. 55.2%), and white (77.2% vs. 66.7%). After adjusting for covariates, compared with the BD - CPD group, the BD + CPD group had 21% more risk of SI/SA (odds ratio, 1.21, p0.001). CPD is independently associated with the increased risk of suicide among patients with BD. Thus, comorbid CPD among patients admitted for BD can be an essential risk factor for suicide.

With the ongoing evolution in genetics, recent evidence highlights the role of circulatory microRNA (miRNA) for schizophrenia. The objective of this article is to explore the role of blood/serum miRNA expression in schizophrenia management and to review the expression of different miRNAs before and after treatment with antipsychotics. miRNAs can help increase the accuracy of diagnosis, identify patients at risk of developing schizophrenia, and possibly predict drug response. The collective evidence from this review showed that several miRNAs are promising candidates for schizophrenia diagnosis, management, and prognosis.

Objectives This study aims to find the prevalence of medication non-compliance among schizophrenia inpatients and to compare the relative risks of medication non-compliance with cannabis use disorders (CUDs) versus without CUDs. In addition, this study also examines the odds of medication non-compliance in schizophrenia inpatients with CUDs. Methods This is a retrospective cross-sectional analysis of the nationwide inpatient sample. This sample includes 1,030,949 inpatients (age 18 to 65 years) from 2010 to 2014 with primary ICD-9 diagnoses of schizophrenia and other psychotic disorders, that were further sub grouped based on medication non-compliance. CUDs were recognized using the ICD-9 codes. Results The prevalence of medication non-compliance was 26% among schizophrenia inpatients. Multivariable analysis revealed that CUD comorbidity was a significant risk factor for medication non-compliance among schizophrenia patients when unadjusted (OR 1.49, 95%CI 1.469–1.503), and association remained significant even after adjusting for covariates (adjusted OR 1.38, 95%CI 1.268–1.489). Comorbid CUD was seen in young adults (18–35 years, 62.4%), males (80.5%), African Americans (54.1%) and low-income families below 25th percentile (48.6%) with personality disorders (10.5%). Conclusion Medication compliance is a challenge among schizophrenia patients, which has a significant adverse impact on the course of illness. CUD Comorbidity increases the risk of medication non-compliance significantly among schizophrenia patients. In addition to case management, an integrated treatment model to address both substance use disorders and psychosis will translate into better long-term outcomes in schizophrenia patients.

Introduction. Insomnia is an important symptom associated with major depressive disorder (MDD). In addition, it is one of the risk factors for suicide. Studies have shown the relationship be-tween insomnia and suicidal behavior in patients with MDD. However, this association has not been evaluated in a large sample of hospitalized patients. Objectives. To evaluate the suicidal be-havior in MDD patients with insomnia compared to those without insomnia. Methods. From the National Inpatient Sample (NIS 2006–2015) database using the ICD-9 code, patients’ data were obtained with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+I). These patients were compared with MDD patients without insomnia disorders (MDD–I) by performing a 1:2 match for the primary diagnosis code. Suicidal ideation/attempt da-ta were compared between the groups by multivariate logistic regression analysis. Results. After the diagnostic code matching, 139061 patients were included in the MDD+I group and 276496 patients in the MDD–I group. MDD+I patients were older (47 years vs. 45 years, p < 0.001) com-pared to the MDD–I group. The rate of suicidal ideation/attempt was 56.0% in the MDD+I group and 42.0% in the MDD–I group (p < 0.001). After adjusting for age, sex, race, borderline personal-ity disorders, anxiety disorders, and substance use disorders, ‘insomnia’ was associated with 1.71 times higher odds of suicidal behavior among MDD patients admitted to the hospital. (Odds ratio: 1.71, 95% confidence interval 1.60–1.82, p < 0.001). Conclusions. Insomnia among MDD patients is significantly associated with the risk of suicide. MDD patients with insomnia need to be closely monitored for suicidal behavior.

In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.

DiGeorge Syndrome (DGS) is a common multisystem disorder associated with deletions on chromosome 22q11.2. Our objective is to evaluate the psychiatric comorbidities and demographics of patients suffering from DGS in a nationally representative dataset on inpatient hospitalizations.The Nationwide Inpatient Sample for the year 2005-2017 was used for this study. Data on patients with DiGeorge syndrome were collected by using the International Classification of Diseases code. Univariate and multi- variate logistic regression analysis was performed.In our study, the average age was 30.4 years (n = 6,563), with 59.9% male, and 61.8% of patients were white. There was a high prevalence of mood disorders (24.7%) and anxiety disorders (16.4%), followed by schizo- phrenia and other psychotic condition (14.0%). In patients with mood disorders, 8% had Major Depressive Disorder, and 7% had bipolar depression. Overall composite of psychiatric comorbidities was present in 2,959 (45.1%) of patients. The mean length of stay was 6.58 days, and 77% of patients had routine discharge to home. In the adjusted analysis, the average length of stay was 8.6 days vs. 6.7 days (p0.001) in patients with and without psychiatry comorbidities. In comparison to routine discharge, patients with psychiatry comorbidities were more likely to be discharged to other healthcare facilities (odds ratio [OR]: 1.28, p0.001) and discharged against medical advice (OR: 3.45, p0.001).Patients with DGS have worse outcomes with a higher rate of discharge to other healthcare facilities and a higher rate of being discharged against medical advice. Further large scale randomize studies are indicated.

BACKGROUND Major depressive disorder (MDD) is the most common psychiatric disorder characterized by changes in mood, cognition, and physical symptoms. MDD has an approximate 18% prevalence of comorbid OSA. Several studies have looked into plausible mechanisms that have shown a strong relationship between OSA and MDD. OBJECTIVES The primary objective of this study was to compare suicidal ideation/attempt among MDD patients with and without a comorbid diagnosis of OSA. The secondary objective was to compare the length of stay, total hospital charge, recurrent or severity of depression, and clinical comorbidities. METHODS Data were obtained from the National (Nationwide) Inpatient Sample dataset from 2006 to 2017. For data collection, we queried for all adult patients (age ≥ 18 y), with MDD as a primary indication of admission. Further, we categorized MDD patients with and without a secondary diagnosis of OSA. To reduce the imbalance in baseline characteristics between the groups, we performed one to one age-gender matching between MDD patients with and without OSA. RESULTS In the matched cohort, 79,308 patients were included in MDD with OSA and 78,792 patients in the MDD without OSA group. MDD patients with OSA were more likely to be racially white (80% vs 75%, P < 0.001), and to have more clinical comorbidities (hypertension, heart failure, obesity, and chronic lung disease). Prevalence of recurrent type of depression (77% vs 69%, P < 0.001) and moderate to severe depression (72% vs 68%, P

Objective To discern the demographic predictors in bipolar disorder (BD) manic patients receiving combination regimen, that is, lithium and antipsychotic, and to study the impact of a combination regimen on hospitalization length of stay (LOS) and total charges. Methods We used the nationwide inpatient sample (NIS) and included 1,435 adult inpatients with BD, manic episodes, and receiving lithium. Independent sample T-test with equality measures was used for LOS and total charges. Logistic regression model was used to find the odds ratio (OR) for the combination regimen to estimate the predictors with 95% CI. Results Among the inpatient sample, 34.5% received a combination regimen. There was statistically no significant difference between the combination regimen versus non-combination regimen cohorts by age and sex. A higher proportion of inpatients receiving combination regimen were from high-income families above 75th percentile (56.4%) and covered by private insurance (47.5%). Blacks (OR 2.00, 95% CI 1.43-2.82) and hispanic (OR 2.31, 95% CI 1.49-3.57) had higher odds of receiving a combination regimen compared to whites. The combination regimen significantly reduced LOS for BD, manic episode management by 2.8 days (95% CI 1.13-4.53 days, P < 0.001). There was statistically no significant mean difference in total charges (P = 0.495). Conclusion A combination regimen with lithium and antipsychotics significantly reduced LOS for BD manic episodes by 2.8 days compared to inpatients receiving lithium monotherapy. So, starting the combination regimen from the initial day of hospitalization should be considered as an effective model for faster response.

Objectives To understand the region-wise differences in demographics, comorbid substance abuse, and hospital outcomes in adult schizophrenia inpatients with cannabis abuse and medication non-compliance. Methods We included 51,975 adults (18-65 years) from the Nationwide Inpatient Sample (2012 to 2014) with a primary diagnosis of schizophrenia and comorbid diagnosis of cannabis abuse and medication non-compliance. We used descriptive statistics and linear-by-linear association to evaluate the region-wise differences in demographics and comorbid substance abuse. Analysis of variance was used for continuous variables such as length of stay (LOS) and total charges during hospitalization to measure the differences across the regions. Results Our study inpatients were from the United States regions: northeast ([NE] 30.4%), midwest ([MW] 24.3%), south (27.3%), and west (18%). A higher proportion of young adults (age: 18-35 years; overall total: 62.4%) were from the south (65.1%) and the NE (64.3%) regions. The study population comprised majorly of males in all the regions, ranging from 78.6% to 82.2% (overall total: 80.5%). The west region comprised majorly of whites (42.6%), whereas all other regions majorly had blacks, with the highest seen in the MW (63.2%) and south (63%) regions. The most prevalent comorbid substances in the study inpatients were tobacco (46.3%) and alcohol (32.3%). The mean LOS and total charges for the hospitalization were much higher in the NE region (LOS: 15.8 days; total charges: $44,336). Conclusion Cannabis abuse and medication non-compliance in schizophrenia patients were prevalent in the NE region of the United States and in the overall regions, and affects young adults, males, and Blacks from low-income families. This is associated with higher hospitalization stay and cost, which indirectly increase the healthcare burden.

Objectives Our main goal is to understand the demographics and psychiatric comorbidities and to evaluate the risk of suicidal behaviors in post-traumatic stress disorder (PTSD) adolescents. Methods We included 159,500 adolescents (age, 12 to 18 years) with a primary psychiatric diagnosis from the Nationwide Inpatient Sample from January to December 2014 and grouped them by a diagnosis of PTSD (N = 21,230 [13.3%]). A logistic regression model was used to measure the odds ratio (OR) for suicidal behaviors in PTSD versus non-PTSD cohorts. Results A higher proportion of PTSD adolescents were females (75.7%) and whites (63.6%). The most prevalent psychiatric comorbidities in PTSD inpatients (vs. non-PTSD) were anxiety disorders (100% vs. 31.9%) and mood disorders (89.4% vs. 84.7%). About 48.7% of PTSD inpatients had suicidal behaviors and had a higher risk (OR 1.23; 95% CI: 1.19-1.26; P < 0.001) compared to that seen in 43.6% of the non-PTSD cohort. Conclusions Diagnosis of PTSD is prevalent in adolescents, especially females and whites, with anxiety and mood disorders being the most prevalent comorbidities. There exists a significant association between PTSD and suicidal behaviors, with an increased risk of 23% in adolescents.

IntroductionInsomnia is strongly associated with Major depressive disorders (MDD). There is strong evidence that it is one of the risk factor for suicide. Studies have shown the relationship of suicidal behavior in MDD patients with insomnia. However, it has not been evaluated in a large inpatient sample.ObjectivesTo evaluate suicidality in MDD patients with insomnia compared to those without insomnia.MethodsFrom the National Inpatient Sample (NIS 2006-2015) database using ICD-9 code, we obtained patients with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+S). We compared it with MDD patients without insomnia disorders (MDD-S) by performing a 1:2 match for primary diagnosis code in the unweighted dataset. Suicidal ideation/attempt data were compared between the groups by multivariate logistic regression analysis.ResultsAfter the diagnostic code matching, 139061 patients were included in the MDD+S group and 276496 patients in the MDD- S group. MDD+S patients were older (47 years vs 45 years, p < 0.001) compared to the MDD-S group. Prevalence of Suicidal ideation/attempt was 56.0% in the MDD+S group and 42.0% in the MDD-S group (p < 0.001). After adjusting for age, sex, and race, MDD+S was associated with 1.8 times higher odds of suicidal behavior compared to the MDD-S group. (Odds ratio: 1.79, 95% confidence interval 1.68-1.91, p < 0.001).ConclusionsInsomnia in MDD patients is significantly associated with the risk of suicide. It is important to be watchful for insomnia in MDD patients.DisclosureNo significant relationships.

Introduction Bipolar disorder (BPD) is associated with suicidality in adult population. There are several risk factors for suicide, however the relationship between Obstructive Sleep Apnea (OSA) and suicidality in patients with BPD has not been explored. Hence, we decided to perform this study with primary objective of comparison of suicidality by OSA diagnosis in patients with BPD. Methods We used inpatient hospitalization data from National Inpatient sample dataset year 2016–2018. Our primary population (BPD + OSA) was composed of adult patients admitted to the hospital with the primary diagnosis of Bipolar Disorder and secondary diagnosis of Obstructive sleep apnea. Age-gender matched (1:4 matching) control population was selected with primary diagnosis of BPD having no OSA (BPD-OSA). Data on suicidality (suicidal ideation/attempt) were collected and compared between the groups using logistic regression analysis methods by including OSA, age, gender, race, substance use disorder and personality disorder as predictors. Results From the dataset, 17895 patients were obtained for the BPD + OSA group (average age: 50.5 years, male 45.5%). After 1:4 age-gender matching, 71575 patients were included in the BPD-OSA group. In the unadjusted analysis, suicidal ideation was significantly high BPD+OSA group compared the BPD-OSA group (38.4% vs. 31.9%, p < 0.001). Rate of suicide attempt and self-inflicted injuries were similar in two groups (3.5% vs. 3.3%, p: 0.27). In the adjusted logistic regression analysis odds of suicidality were 36% more in BPD+OSA group compared to BPD-OSA (Odds Ratio: 1.36, 95% Confidence interval: 1.25–1.48, p < 0.001). Conclusion In adult patients with BPD, diagnosis of OSA significantly increases the odds of suicidality. Addressing OSA in patients with BPD, can improve management, and potentially reduce the incidence of suicide. We believe our study will be helpful in guiding future research and development on this issue. Support (if any) None

IntroductionRecently, several studies have shown both positive and negative impacts of social media on mental health. However, little is known regarding the reasons for the negative impact of social media on mental health.ObjectivesTo evaluate the role of social media on mental health.MethodsWe reviewed the documentary ‘The Social Dilemma’ released on Netflix in September 2020, which explored the role of social media in our life. The documentary discussed the behind the scene development of the social media world.ResultsThe central message from the documentary is that all the social media applications we use are capable of hijacking the thought process of your brain and are consciously designed by the artificial intelligence technology in a way that one spends more time on them. It collects users’ data such as topics they like, follow, search, subscribe, shop, and several others. Based on this data it feeds you the information according to your taste and next time you log in on the website, you spend more time on it. This causes positive reinforcement, the more time you spend on a particular topic, the more you will be presented which results in addictive behavior.ConclusionsIt is known that social media addiction is prevalent, and it affects brain like drug and alcohol addiction. This documentary provided technological insight into this type of behavior. Though social media has its pros, it has numerous cons despite being used for right intentions. Better regulatory measures are needed to prevent psychological disorders related to social media usage.DisclosureNo significant relationships.