Stanytė, Agnė

Background: Fatigue is one of the main symptoms in anxiety or mood disorders (AMDs). Despite this, different qualitative subjective fatigue dimensions (e.g., physical fatigue, mental fatigue, etc.) have not been researched in relation to depression and especially anxiety symptom severity. The current study examined the associations between depression and anxiety symptom severity and fatigue characteristics in individuals with AMDs.

Social media increasingly shapes body image by promoting often unattainable beauty ideals. Concurrently, targeted online marketing of image- and performance-enhancing drugs (IPEDs) exploits these vulnerabilities, intensifying anxiety and fostering maladaptive behaviours such as problematic usage of the internet (PUI), compulsive exercise, and IPEDs consumption. This study explores these behaviours across nine countries and examines how PUI, excessive exercise, and IPEDs use predict appearance anxiety, aiming to inform targeted prevention strategies for at-risk populations.

Background Obsessive-compulsive personality disorder (OCPD) is common in individuals with anxiety and mood disorders (AMD), yet its specific impact on cognitive functioning remains underexplored. Individuals with AMD often experience persistent cognitive difficulties [1]. Meanwhile, OCPD is associated with a distinct neuropsychological profile characterized by cognitive inflexibility and executive planning impairment [2,3]. However, it is still unclear to what extent cognitive impairments in AMD population are influenced by OCPD. Therefore, the aim of our study was to compare the cognitive performance of individuals with AMD with and without comorbid OCPD. Based on previous studies [2, 3], we hypothesized that individuals with AMD and comorbid OCPD will have a distinct cognitive pattern in the areas of Intra-Extra Dimensional (IED) Set Shifting, One Touch Stockings of Cambridge (OTS), but not in Cambridge Gabling Task (CGT). Methods Overall, 24 individuals (75% women, mean age 40.0 [35.5–50.5] years) with AMD took part in the study. OCPD traits were evaluated using the observer-rated Compulsive Personality Assessment Scale (CPAS) [4]. The diagnosis of OCPD was defined as a score of three (severe) and four (very severe) on at least four of the CPAS items. Individuals that did not meet the operational criteria for OCPD but scored higher than 5 were excluded from the study. Neurocognitive testing was done with the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (IED Set Shifting), executive functions (OTS), and decision making and risk-taking behavior (CGT). Chi-square test and Mann Whitney U test were used for comparison within groups. Results Out of 24 participants, 13 individuals fulfilled the operational criteria for OCPD (84.6% women, mean age 41.0 [34.5–50.0]), while 11 individuals (63.6% women, mean age 39.0 [37.0–53.0]) were classified without OCPD, as they scored 0–5 points on the CPAS. The groups did not differ in regards to sociodemographic characteristics, such as age, gender, education, history of smoking, diagnosis, severity of depression and anxiety (all p > .05). Comparing neuropsychological tests scores, individuals with OCPD made less mistakes on the IED problems prior to the extra-dimensional shift (6.0 [6.0–8.0] vs. 5.0 [4.0–6.0], p = .019, effect size r = 0.478). Individuals with OCPD made less IED compound reversal errors (1.0 [1.0–2.0] vs 1.0 [1.0–1.0], p = .049, effect size r = 0.401), but made more IED extradimensional reversal errors (1.0 [1.0–1.0] vs 1.0 [1.0–3.0], p = .039, effect size r = 0.420). There were no significant differences between groups in other cognitive function domains. Conclusions Individuals with AMD and comorbid OCPD experienced difficulties in cognitive flexibility that are not present in individuals with AMD without OCPD. They showed a better performance on tasks involving rule acquisition and consistency, but had significant difficulties when task required flexibility and attentional shifting. Deficits in cognitive flexibility could be the basis for OCPD trait compulsivity, which in turn could have clinical implications for individuals with AMD. These findings expand on the neuropsychological OCPD research, highlighting cognitive inflexibility in individuals with AMD and comorbid OCPD. Nevertheless, small sample size limits the generalizability of our results, and future studies are needed to confirm these findings.

Background: Thyroid axis hormones, such as free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) are associated with mental disorders, especially with depression and anxiety [1, 2]. These hormones have been associated with worse cognitive functioning in individuals with coronary artery disease [3]. Cognitive dysfunction is prevalent in individuals with anxiety and mood disorders (AMD) [4, 5], however, the associations between these variables have not been studied in individuals with AMD. Therefore, the aim of our study was to investigate the correlation between fT3, fT4, the fT3/fT4 ratio, TSH and cognitive functioning in individuals with AMD. Methods: One hundred and ninety-two (age 39±12 years; 21% men and 79% women) individuals attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, took part in this cross-sectional study. Diagnoses of AMD were established using the Mini-International Neuropsychiatric Interview. Cognitive tests were completed in order to assess cognitive functioning. Participants completed Digit Span Test to assess auditory attention and Trail Making Test (TMT) A and B to assess their perceptual speed, task-switching and executive control characteristics. Venous blood samples were drawn for evaluation of fT3, fT4, and TSH. Blood was centrifuged and serum was stored frozen at -70˚C. Serum levels of fT3, fT4, and TSH were analysed using an automated enzyme immunoassay analyser. Depression symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms were measured with the Generalized Anxiety Disorder-7 (GAD-7). For statistical analyses, univariate regression analysis was used to examine unadjusted associations of fT3, fT4, TSH, and fT3/fT4 with scores on cognitive functioning tests. Then, multivariable regression analyses were performed to determine if fT3, fT4, TSH, and fT3/fT4 remained significantly associated with cognitive functioning after adjusting for age, sex, education, depression and anxiety symptoms, smoking, and current medication use. Results: In individuals with AMD, univariate regression analyses showed that fT3 had a negative correlation with TMT Part A (b=-0.206; p=0.004), and Part B (b=-0.145; p=0.046); however, these associations were not significant in multivariable analyses after adjusting for age, sex, education, depression and anxiety symptoms, smoking, and current medication use. A univariate regression analyses also showed a negative correlation between fT4 and TMT Part A (b=-0.210; p=0.004), as well as Part B (b=-0.152; p=0.036). These associations were significant even after controlling them for aforementioned confounding factors (b=-0.192; p=0.006; b=-0.151; p=0.036 respectively). Conclusions: Overall, in individuals with AMD, lower fT4 concentrations were associated with slower perceptual speed and worsened task-switching abilities independent of socio-demographic characteristics, clinical factors as well as depression and anxiety symptoms. The results show the importance of thyroid hormones on cognitive functions in individuals with AMD. Particularly lower fT4 could be a potential biomarker of impaired cognitive functioning in individuals with AMD.

One of the most common symptoms of various psychiatric disorders, especially anxiety and mood disorders, is mental fatigue. Despite the high prevalence and effect on everyday life mental fatigue is still highly underresearched in the area, as it still does not have a unified definition or assessment method when it comes to individuals with psychiatric disorders. This chapter discusses the current state of mental fatigue research in individuals with psychiatric disorders, starting with the prevalence, assessment, and definition, proceeding with the overview of the findings on the main factors associated with mental fatigue, such as sleep, cognitive functions, and stress, and ending with possible intervention methods.

Background: Impaired Health related Quality of Life (HRQoL) is a common burden among individuals with mental health conditions, especially in those with anxiety and mood disorders (AMD). Obsessive–compulsive personality disorder (OCPD) is one of the most common personality disorders in the general population, is even more prevalent in individuals with AMD, and has also been linked to excessive mental fatigue in this group. Nevertheless, there have been very few studies exploring the impact of OCPD on HRQoL in patients with AMD. Our objective was to investigate the relationship between OCPD and HRQoL in individuals with AMD. Methods: A cross-sectional study included 235 persons (with a mean age of 41 and SD of 12 years) with AMD attending the Stress Disorders Unit at Hospital Palanga Clinic, Neuroscience Institute, Lithuanian University of Health Sciences. The SF-36 scale was used to assess eight aspects of HRQoL: physical functioning, rolephysical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning, and mental health. The Compulsive Personality Assessment Scale (CPAS) was used to assess features associated with OCPD. The nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety symptoms in individuals with AMD. Two-tailed Student’s t-test or Fisher’s χ2 were used to compare socio-demographic, clinical, HRQoL, depression, and anxiety characteristics between individuals with and without OCPD. Subsequently, separate multivariable linear regression analyses were performed within each group (OCPD and non-OCPD) to examine the associations between OCPD traits and HRQoL, while controlling for potential confounders. Results: Subjective social functioning, mental health, vitality and general health perception were found to be worse in individuals with OCPD in comparison to group with no OCPD. In individuals with OCPD, the links between OCPD traits and HRQoL remained significant only in the domain of vitality (β = –0.236, p < 0.042), after controlling for age, gender, education, marital status, medication use and depressive and anxiety symptoms. OCPD trait severity was not associated with HRQoL domains in individuals without OCPD. Conclusions: In individuals with AMD, the presence of OCPD was related to poorer HRQoL, particularly in the vitality domain, after controlling for socio-demographic and clinical characteristics. This study sheds new light on the impact of OCPD on quality of life in individuals with AMD and aligns with our previous findings linking OCPD to mental fatigue. Limitations of the study include its cross-sectional design and use of brief measures to assess anxiety/ depressive symptom severity. Future research should now explore mechanisms underlying these associations, and evaluate whether the findings generalise to larger, more diverse samples.

Background: Fatigue is a common complaint among individuals with anxiety and mood disorders (AMD) [1]. Subjective fatigue is closely related to cognitive functioning in healthy adult population [2], as well as in other populations, such as individuals with coronary artery disease [3]. Even though cognitive dysfunction and fatigue are both more common in individuals with AMD than in otherwise healthy individuals [4], the relationship between fatigue and cognitive functions is still underexplored. Furthermore, most research on fatigue relies primarily on self-report measures, often lacking objective assessments to compare with. Therefore, the aim of our current study was to investigate the correlations between subjective and objective fatigue and cognitive functions in individuals with AMD. Methods: Three hundred and fourteen individuals (77.7% women and 22.3% men, mean age 40.2 ± 11.9 years) attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, participated in this cross-sectional study. Diagnosis of AMD was established using the Mini-International Neuropsychiatric Interview. Subjective fatigue was assessed using the Multidimensional Fatigue Inventory-20 (MFI-20), while objective fatigue was evaluated via an exercise capacity (EC) workload test. Cognitive functioning was measured using Digit Span Test, Digit Symbol Test, Trail Making Test (TMT) Parts A and B. Depression and anxiety symptoms were evaluated with The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. Associations between fatigue and cognitive functioning were first analysed using univariate regression. Multivariable regression analyses were then conducted, adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety symptoms. Results: In individuals with AMD, univariate regression analyses found associations between subjective and objective fatigue characteristics and cognitive functions. Specifically, higher scores on the MFI-20 subscales for reduced activity and reduced motivation were associated with lower T-scores on TMT Part A (β = −0.117, p = 0.039; β = −0.112, p = 0.048 respectively); higher EC was associated with higher numbers of pairs recalled correctly in Digit Symbol Test (β = 0.195, p = 0.001), higher TMT Part A T-score (β = 0.156, p = 0.011), and higher TMT Part B T-score (β = 0.125, p = 0.041). After completing multivariable regression models adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety scores, only the association between higher EC and higher number of pairs recalled correctly in Digit Symbol Test remained statistically significant (β = 0.227, p = 0.002). Additionally, multivariable regression analysis found that higher EC was independently associated with higher TMT A/B T-scores (β = 0.152, p = 0.046). Conclusions: Overall, in individuals with AMD, objective fatigue, as measured by EC, was independently associated with poorer cognitive functioning, particularly in domains involving incidental learning, recall, and executive functioning. These findings underscore the importance of distinguishing between subjective and objective fatigue measures and their respective impact in cognitive performance. These findings have practical implications for better understanding the relationship between cognitive functions and fatigue in individuals with AMD and provide the basis for future research investigating the relationship between cognitive function and fatigue.

Introduction: Image- and performance-enhancing drugs (IPEDs) include a wide range of substances used to alter physical performance or appearance. They are a growing public health concern linked to bodyimage disturbances and maladaptive exercise behaviours. The present study examined the role of exercise addiction, appearance anxiety, and self-compassion in predicting IPED use in a cross-cultural sample of individuals engaged in sports, both professional and non-professional. Methods: This cross-sectional study, based on an online questionnaire and volunteer participation, is part of the Keep Fit 3 survey conducted in nine countries (UK, Spain, Lithuania, Hungary, Japan, Italy, Portugal, Singapore, and Mexico) between May 2023 and June 2024. The survey included the Exercise Addiction Inventory, the Appearance Anxiety Inventory, and the Self-Compassion Scale. Based on IPED use, individuals were classified as non-users, non-harmful users, or potentially risky users. Multinomial logistic regression was used to examine associations between IPED use and potential predictors. Results: Of the 3,514 participants, 71.7% (n=2,521) reported not using any supplements, 8.1% (n=286) reported using non-harmful IPEDs, and 20.1% (n=707) eported using potentially risky IPEDs. We found that non-harmful and potentially risky IPED use were associated with age, sex, appearance anxiety, and exercise addiction in the overall sample and among non-professional athletes, whereas only potentially risky IPED use was related to sex, appearance anxiety, and exercise addiction among professional athletes. Conclusions: Our results highlight risk factors associated with IPED use and the specific characteristics of use among professional athlete populations. Clinicians, trainers, and mental health professionals should be more aware of the risks associated with IPED consumption and possible related psychopathologies and dysfunctional behaviours.

Cardiovascular diseases such as coronary artery disease (CAD) have a high prevalence of psychiatric comorbidities, that may impact clinically relevant outcomes (e.g., cognitive impairment and executive dysfunction). Obsessive-compulsive personality disorder (OCPD) is a common psychiatric comorbidity in CAD. It has a distinct cognitive profile characterised by inflexible thinking and executive dysfunction, which in turn may affect treatment adherence. However, the impact of OCPD on cognitive functioning in CAD is under-researched. We aimed to investigate the impact of OCPD on executive function in individuals with CAD undergoing rehabilitation, using cognitive tests relating to inflexibility and executive planning.

Background: Fatigue is one of the main symptoms and predictors for anxiety and mood disorders (AMD) [1, 2]. More researched in depressive disorder, fatigue is often described as a residual symptom, persisting even after a successful treatment of antidepressants [3] and causing functional limitations as well as a reduced quality of life [4]. Despite the debilitating effects of fatigue on everyday life, it has been found that loss of energy as a symptom is not more frequent in individuals with major depressive disorder as depression severity rises [5]. However, fatigue consists not only of loss of energy, but different fatigue characteristics have not been studied in relation to AMD symptom severity. Therefore, the aim of our current study was to investigate the correlation between depression/anxiety symptom severity and fatigue characteristics in individuals with AMD. Methods: Two hundred and thirty-three individuals (21.5% men and 78.5% women, mean age 39 years old [95% CI 37.4-40.5]) attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, took part in this cross-sectional study. Diagnosis of AMD was established using the Mini-International Neuropsychiatric Interview. Participants completed the Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) questionnaires to assess depression and anxiety symptom severity, as well as Multidimensional Fatigue Inventory-20 (MFI-20) self-report questionnaire to assess characteristics of subjective fatigue: general, physical, and mental fatigue, as well as reduced activity and motivation. Then, a multivariable regression analysis was used to examine the associations between depression/anxiety symptom severity and subjective fatigue characteristics, adjusted by age, sex, education, body mass index, smoking, current medication use. Results: In individuals with AMD, severity of depressive symptoms, as measured by PHQ-9, was positively associated with general fatigue (β=0.366, p<0.001), physical fatigue (β=0.503, p<0.001), reduced activity (β=0.603, p<0.001), reduced motivation (β=0.511, p<0.001), and mental fatigue (β=0.459, p<0.001) after controlling for age, sex, education, body mass index, smoking, and current medication use. In individuals with AMD, severity of anxiety symptoms, as measured by GAD-7, was positively associated with general fatigue (β=0.185, p=0.032), and negatively associated with reduced activity (β=-0.085, p=0.032) after controlling for age, sex, education, body mass index, smoking, and current medication use. Conclusions: Overall, in individuals with AMD the severity of depressive symptoms was positively associated with all subjective fatigue characteristics, meaning that individuals with AMD who had higher severity of depressive symptoms also reported higher levels of general, physical and mental fatigue, as well as higher levels of reduced activity and motivation. On the other hand, in individuals with AMD the severity of anxiety symptoms was associated with higher levels of general fatigue and lower levels of reduced activity. The results show that the severity of depressive symptoms has a higher influence on manifestations of fatigue and could have clinical significance in AMD cases.