CNS Spectrums最新文献

This chapter discusses the Dutch Law on Compulsory Mental Healthcare (Wvggz), which aims to strengthen the autonomy of patients with severe mental disorders by recognizing that coercive measures can be used not only to prevent harm, but also to restore autonomy. This approach challenges the traditional notion that coercive measures inherently undermine autonomy. The chapter also explores the unintended consequences of the law, such as increased bureaucracy. We argue that while the Wvggz introduces valuable ideas, its practical implementation has highlighted the challenges of translating legislative goals into effective practices.

Objectives: Much work has been done on the role of trauma in obsessive-compulsive disorder (OCD), but the relationship between stressful life events (SLEs) and the onset of OCD remains poorly studied. This study aims to summarize the evidence about the association between SLEs and OCD development.

Methods: For this systematic review, we searched PubMed, Web of Science, Scopus, and PsycINFO databases for studies published from the database's inception to December 12, 2024. We included studies investigating the prevalence of SLEs among individuals diagnosed with OCD compared to other psychiatric disorders or healthy controls.

Results: Seven studies met the inclusion criteria and were incorporated. Two studies found that OCD patients suffered more SLEs than healthy controls in the year before the onset of OCD. Two of the included studies showed a higher occurrence of SLEs across the patients' lifetime before the onset of OCD. Three studies were comparable and, therefore, meta-analyzable. Together, they revealed that SLEs in the year before the onset of OCD were associated with a small yet positive pooled effect size.

Conclusions: Our review suggests that SLEs may be highly represented among people with OCD both in the year preceding the disorder's onset and throughout their lifetime.

Continuous glucose monitoring (CGM) has revolutionized diabetes management by providing real-time data on blood glucose fluctuations. Unlike traditional methods, CGM systems offer continuous feedback, enabling individuals to better regulate glucose levels in response to lifestyle factors such as diet, exercise, and stress. This technology has been shown to improve glycemic control and stabilize HbA1c levels. Beyond its primary role in diabetes management, emerging research highlights the relationship between metabolic health and mental wellbeing. Glucose dysregulation has been implicated in mood instability, and fluctuations in blood glucose levels may directly influence emotional states. Notably, some researchers have proposed reclassifying major depressive disorder (MDD) as "Metabolic Syndrome Type II" due to shared pathophysiological mechanisms involving glucose homeostasis and inflammation. Given these connections, CGM technology may offer mental health benefits by promoting glucose stability. For individuals with diabetes who also experience psychiatric conditions such as MDD or generalized anxiety disorder (GAD), CGM use may contribute to improved mood regulation and reduced psychiatric symptoms. By addressing both metabolic and mental health concerns, CGM holds promise as a valuable tool in enhancing overall wellbeing. Further research is warranted to explore the full potential of CGM in supporting mental health outcomes in individuals with metabolic disorders.

It was found that a significant number of patients with major depressive disorder (MDD) did not respond to the treatment, leading to high ongoing costs and disease burden. The main objective of this study was to find neurobiological indicators that can predict the effectiveness of antidepressant treatment using diffusion tensor imaging (DTI). A group of 103 patients who were experiencing their first episode of MDD were included in the study. After 2 weeks of SSRI treatment, the group of patients was split into two categories: ineffectiveand effective. The FMRIB Software Library (FSL) was used for diffusion data preprocessing to obtain tensor-based parameters such as FA, MD, AD, and RD. Tract-Based Spatial Statistical (TBSS) voxel-wise statistical analysis of the tensor-based parameters was carried out using the TBSS procedure in FSL. We conducted an investigation to determine if there were notable variations in neuroimaging attributes among the three groups. Compared to HC, the effective group showed significantly higher AD and MD values in the left CgH. Correlating neuroimaging characteristics and clinical manifestations revealed a significant positive correlation between CgH-l FA and clinical 2-week HAMD-17 total scores and a significant positive correlation between CgH-r FA and clinical 2-week HAMD-17 total scores. Functional damage to the cingulum bundle in the hippocampal region may predispose patients to MDD and predict antidepressant treatment outcomes. More extensive multicenter investigations are necessary to validate these MRI findings that indicate treatment effectiveness and assess their potential significance in practical therapeutic decision-making.

Objective: Brain age gap estimation (BrainAGE) has demonstrated accelerated brain aging in mild cognitive impairment (MCI) and functional aging in patients with Alzheimer's disease (AD). Nevertheless, the neuroanatomical aging characteristics of AD remain insufficiently understood. The present study aimed to investigate the neuroanatomical aging conditions of AD using the BrainAGE model.

Methods: Clinical profiles and T1 structural magnetic resonance imaging (MRI) data of 219 healthy controls (HCs) and 51 AD patients were collected. We extracted gray matter and white matter volumes from the structural MRI and used the BrainAGE model to evaluate aging characteristics in AD patients. Specifically, we configured a stacking model with two levels to predict brain age. The model was trained on the 219 HCs and tested on the AD patients to investigate whether AD could lead to different neuroanatomical aging conditions. In addition, we explored differences in voxel-wise gray matter, white matter patterns, and clinical profiles between AD patients with different neuroanatomical aging conditions.

Results: The proposed machine learning algorithm could accurately estimate brain age in HCs. Application of the BrainAGE model to the AD group revealed three subgroups with advanced, typical, and delayed brain aging conditions. The three AD subgroups also differed in voxel-wise gray matter and white matter volumes. Furthermore, the three subgroups differed in age and genetic scores.

Conclusion: The BrainAGE model identified subtle deviations from age-related brain atrophy in the AD cohort with distinctive clinical manifestations, which contribute to the understanding of neuropathology of AD.

Objective: To investigate whether anxiety reductions attributed to healing crystals reflect placebo responses driven by conditioning and belief-related biases rather than specific therapeutic effects.

Methods: In a randomized, controlled study, 138 adults were classified as believers or nonbelievers in crystal efficacy and assigned to rose quartz (experimental) or a visually matched placebo. Participants followed a standardized 14-day protocol. Anxiety was assessed pre- and post-intervention with the Beck Anxiety Inventory and the Spanish Kuwait University Anxiety Scale. Multilevel analyses of variance (ANOVA) and Bayesian models were used to evaluate main effects, interactions, and evidence for treatment specificity.

Results: Anxiety reductions occurred only among believers, regardless of crystal assignment. No differences were detected between groups in primary outcomes, and improvements did not exceed the magnitudes typically associated with placebo responses. Bayesian estimates favored the null hypothesis for specific treatment effects. Preexisting belief strongly predicted perceived efficacy and symptom change, consistent with causal illusions plausibly shaped by conditioning mechanisms. Nonbelievers showed no reliable improvement.

Conclusion: Healing crystals did not demonstrate anxiolytic effects beyond those of the placebo. Symptom change was mediated by expectancy and conditioning, particularly in individuals inclined toward intuitive or magical thinking. Although nonspecific, context-dependent factors-such as elements of the therapeutic alliance-may amplify placebo responsiveness in clinical settings, these findings do not support attributing inherent therapeutic value to crystals. Future work should delineate how expectations, clinician-patient rapport, and related variables interact to shape placebo response and how such mechanisms might be ethically leveraged to enhance evidence-based care without promoting pseudoscientific practices.

Schizophrenia is known to be a disabling psychiatric condition with wide reaching impact on everyday functioning and outcomes. These functional outcomes include increases in all-cause mortality (especially suicide and injury), cognitive and functional capacity deficits, lower reported levels of quality of life (QoL), increased incarceration, higher risk for violence and victimization, and homelessness. Studies have shown that medications and outpatient services can improve each of these functional outcomes in individuals with schizophrenia. However, most studies of pharmacological treatment utilize rating scales that do not reflect these real-world outcomes. This review looks at available studies focused on real-world outcomes and argues for an expansion of this body of research.

Background: Obsessive-compulsive disorder (OCD) is a significantly disabling and difficult-to-treat psychiatric disorder. Non-invasive neuromodulation techniques like repetitive transcranial magnetic stimulation (rTMS) have been increasingly used in the management of OCD. This study aimed to compare the efficacy of early augmentation with low-frequency rTMS (LF-rTMS) and continuous theta burst stimulation (cTBS) in improving psychopathology in OCD patients.

Methods: The study design was a parallel-group, double-blind, randomized clinical trial. The study recruited 46 OCD patients who were randomly allocated to receive either LF-rTMS or cTBS (23 patients in each group) following the computer-generated random table method. All participants were rated on YBOCS, HAM-A, and HAM-D at baseline and third week and sixth weeks. These patients received a total of 15 sessions of LF-rTMS or cTBS stimulation once daily for 5 consecutive days in a week for 3 consecutive weeks over the right dorso-lateral pre-frontal cortex (DLPFC) area.

Results: There was a statistically significant improvement in the total YBOCS score for both the LF-rTMS group and the cTBS group at the end of the third and sixth week when compared with their baseline scores. However, there was no statistically significant difference between the 2 groups in terms of the improvement in the total YBOCS score, as well as the total scores for the HAM-A and HAM-D during the follow-up periods.

Conclusion: The study results suggest that both LF-rTMS and cTBS were equally effective in managing OCD patients as an early augmentation strategy.

Schizophrenia is a severe mental disorder with heterogeneous outcomes that depend heavily on symptom stability as a prerequisite for psychosocial rehabilitation and reintegration. Long-acting injectable antipsychotics (LAIs) are a relevant treatment tools that can help advance meaningful outcomes through improved antipsychotic adherence and relapse prevention, deliver pharmacokinetic advantages less achievable with oral formulations, improve patient autonomy, increase functioning, and reduce the risk of premature mortality even more than oral antipsychotics. However, LAIs remain largely underutilized. Non-modifiable and modifiable risk factors for relapse are summarized, potential advantages and disadvantages of LAIs are reviewed, and myths and misconceptions regarding LAIs are outlined and contrasted with evidence. This information is crucial when engaging in shared decision-making and motivational interviewing to educate patients and caregivers about the treatment option of LAIs, including in early illness stages. Since the first episode and early phases of schizophrenia are a defining time, choosing treatments with the greatest potential for improved outcomes is key. In adults with multi-episode schizophrenia, LAIs have shown superiority over oral antipsychotics for relapse/hospitalization and a variety of multiple other efficacy, effectiveness, functionality, and survival metrics. Additionally, LAIs have shown superiority over oral antipsychotics in patients with first-episode/ or early-phase illness, at least in meaningful subgroups of studies and patients that point toward superiority in settings, individuals, and treatment paradigms that more closely match clinical care. Based on this evidence, hesitancies to discuss and offer LAIs in clinical care need to be overcome, framing LAIs not as a last resort but a viable first-line/earlyphase treatment option that can meaningfully transform the long-term course of schizophrenia.