Comprehensive psychiatry最新文献

Background: Childhood adversity is robustly associated with mental ill-health. Yet questions remain about how different ways of conceptualising adversity relate to psychiatric diagnoses and service activity. This research aims to examine associations between typological and cumulative conceptualisations of adversity, and psychiatric diagnosis and service activity.

Methods: We analysed risk assessment data from 21,072 young people attending mental health services in South London. These assessments include items relating to maltreatment, parental mental health difficulties, substance misuse, self-harm, and violent behaviour. Using latent class analysis, we identified the following risk typologies: 'Maltreatment and externalising behaviours' (n = 971, 4·6 %), 'Maltreatment but low risk to self and others' (n = 2526, 12·0 %), 'Anti-social behaviour' (n = 2669, 12·7 %), 'Inadequate caregiver supervision and risk to self and others' (n = 907, 4·3 %), 'Risk to self but not to others' (n = 1725, 8·2 %), and 'Mental health needs but low risk to self and others' (n = 12,274, 58·2 %). Two cumulative risk models were created: 1) all risk items 2) Adverse Childhood Experiences-related cumulative risk (ACES-CR). Controlling for gender, ethnicity, age, and deprivation, we examined associations between risk typologies, cumulative risk, and the following outcomes: 1) psychiatric diagnosis 2) face-to-face appointments 3) missed appointments 4) referral to social services.

Outcomes: Risk in its various conceptualisations was consistently and robustly associated with conduct disorder. Risk also tended to be associated with more face-to-face appointments, missed appointments, and referral to social services. Associations between individual risk typologies and psychiatric diagnosis and service activity are discussed.

Interpretation: Our findings suggest that typological and cumulative approaches to risk and adversity can produce unique insights about diagnostic practices and service activity. This work provides further evidence for the contribution of contextual factors to mental ill-health and further work is required to explore the longer-term trajectories of these young people.

Background: Over 25 % of bipolar disorder (BD) patients are misdiagnosed with major depressive disorder (MDD). An urgent need exists for a biomarker to differentiate BD from MDD. Various manifestations and intensities of maladaptive guilt processing might uniquely contribute to the pathogenesis of BD compared to MDD.

Method: This study adopted a first-person perspective guilt-provoking functional magnetic resonance imaging (fMRI) task, respectively induced by painful and ambiguous scenarios in 111 individuals: 35 with remitted MDD, 38 with remitted bipolar I disorder (BD-I), and 38 matched controls.

Results: A significant interaction between group and sense of agency in predicting guilt ratings for ambiguous, rather than painful, scenarios. The association between sense of agency and guilt was significant in MDD but not in BD-I patients or controls. Activation in the dorsomedial prefrontal cortex (dmPFC), pregenual anterior cingulate cortex (pgACC), and right inferior parietal lobule (IPL) was higher in BD-I than MDD subjects in response to ambiguous scenarios, whereas these were comparable to painful ones. The correlation between guilt ratings and activation in the dorsal anterior cingulate cortex (dACC) to ambiguous scenarios was significant in MDD, but not in BD-I or controls. The results of the multivariate pattern classification analysis showed that in the ambiguous scenarios, the accuracy of using brain activation patterns in the dmPFC, pgACC, and IPL to distinguish between participants with MDD and BD-I was 70.0 %, 71.5 %, and 68.7 %, respectively. An additional test of the classification model, employing a combined mask of the three ROIs to distinguish between the two mood disorders in ambiguous scenarios, achieved an accuracy of 78.6 % and an AUC value of 0.84.

Conclusions: Subjective reports and neural correlates of guilt in ambiguous social situations, as well as a sense of agency, could provide to be a potential biomarker to help distinguish between BD-I and MDD even in the remitted stage.

Background: 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.

Methods: Seventy-eight adults (median age 59 [53.0-66.0] years) with CAD were tested within three days of hospital admission for cardiac rehabilitation occurring within two weeks of experiencing an episode of unstable angina or myocardial infarction. The Compulsive Personality Assessment Scale (CPAS) was used to evaluate OCPD traits. Neurocognitive testing was performed using the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting), and executive planning (Stockings of Cambridge [SOC]).

Results: Ten individuals with CAD fulfilled the operational criteria for DSM-5 OCPD. Individuals with comorbid OCPD made more IED intra-dimensional shift reversal errors (2.0 [2.0-4.0] vs. 1.0 [1.0-2.0], p = .004), reflecting a difficulty inhibiting previously learnt responses. When all participants were analysed as a group, negative associations were found between individual OCPD traits and other aspects of cognitive performance. Hoarding trait was associated with increased initial thinking time on the SOC at five moves (ρ = 0.242, p = .033), while the need for control and rigidity traits were each associated with increased initial thinking time on the SOC at two moves (respectively, ρ = 0.259, p = .022; ρ = 0.239, p = .035), reflecting slower executive planning. A preoccupation with details trait was associated with fewer errors on a compound discrimination stage of the IED (ρ = -0.251, p = .026). After controlling these correlations for gender and age, significant associations remained with hoarding (β = 0.243, p = .036), need for control (β = 0.341, p = .005) and rigidity (β = 0.259, p = .038) traits.

Conclusions: Preliminary evidence suggests that individuals with CAD and comorbid OCPD traits show greater inflexibility than those without OCPD. Several OCPD traits were associated with slower planning, even after controlling them for age and gender. This may have implications for the success of rehabilitation.

Introduction: The association between cognitive functioning and mental health symptoms across the lifespan remains poorly understood. Understanding the directionality of the association between mental health and cognition is important as most gold-standard psychological therapies, such as cognitive-behaviour therapy, are cognitively demanding. Here, we examined the directionality of the association between cognitive and affective control with symptoms of depression and anxiety across the lifespan.

Methods: 1002 participants (87.2 % female, age range: 11-89 years) completed self-report measures of depressive and anxiety symptoms and an affective backward digit span task thrice at 3-month intervals. Cross-lagged panel models (CLPMs) were used to model the longitudinal relationships between affective and cognitive control with depressive and anxiety symptoms. Multiple-group CLPMs were applied to test the model invariance between adolescents and adults.

Results: The results supported a unidirectional relationship, where symptoms of depression and anxiety predicted impaired affective control across time points, over and above cognitive control. There was no evidence for affective or cognitive control capacity predicting emotional disorder symptomatology. In addition, multiple-group analysis revealed that depressive symptoms also predicted impaired cognitive control among adolescents only. There were no age-related differences in the associations between cognitive and affective control with anxiety symptoms.

Conclusions: Our findings support depression and anxiety as antecedents, but not consequences, of impaired affective control. This suggests that timely management of emotional disorders, in particular for adolescents, is essential to prevent deterioration in cognitive functioning. The results further signal that practitioners should consider impaired affective control capacity in therapeutic contexts.

Background: Problematic gaming (PG) has emerged as a major concern due to its potential impact on adolescents' everyday lives. Emotional abuse (EA) and psychoticism are considered factors influencing PG, but their long-term interactions have not been extensively studied. This research investigates these relationships over time using the Interaction of Person-Affect-Cognition-Execution (I-PACE) model.

Methods: The study involved 1902 Italian adolescents (mean age = 15.45, SD = 1.10) in a three-wave longitudinal study. Surveys were conducted at the beginning (T1), after six months (T2), and after twelve months (T3). Structural equation modeling (SEM) was used to evaluate bidirectional relationships and mediation effects among the variables.

Results: The findings indicated that EA consistently predicted both psychoticism and PG, while psychoticism consistently predicted PG. However, psychoticism did not predict EA, and PG did not predict either EA or psychoticism. Significant mediation effects were found from EA at T1 to PG at T3 through EA at T2, psychoticism at T2, and PG at T2, as well as from psychoticism at T1 to PG at T3 through psychoticism at T2 and PG at T2. No significant indirect effect was observed from psychoticism at T2 to PG at T3 through EA at T2.

Conclusions: The results suggest that adolescents experiencing EA are more prone to PG, with psychoticism worsening this effect. Effective interventions might include emotional support programs and therapies targeting psychoticism traits. Combining these approaches could improve treatment outcomes for adolescents with PG.

Background: Currently, approximately 100 million people are displaced worldwide, including children and young adults. Previous studies showed exposure to violence and posttraumatic stress disorder (PTSD) are common in this sub-population. However, we still lack comprehensive data on well-being, mental health, and the ability to function.

Methods: This study included 291 adolescent (aged 12-17 years) and young adult (18-25 years) refugees recruited nationwide in Sweden between 2019 and 2022. Sociodemographic, mental health and well-being-related data (well-being, post-traumatic stress symptoms, psychiatric diagnoses, and functional ability) were collected using semi-structured interviews with structured components. Associations between accompanied status and well-being/depression/suicidal thoughts, generalized anxiety disorder/panic disorder/PTSD symptoms, and functional ability were analyzed using linear and logistic regression, adjusted for age, gender, parental education, asylum status, and region of origin.

Findings: Most study participants (mean age 17·9 years) originated from the Middle East and North Africa (70·6 %) or Sub-Saharan Africa (27·0 %). 16·1 % of adolescents and 32·3 % of young adults were unaccompanied. Nearly the entire study sample had experienced violence (92·8 %). However, the sample had a low prevalence of psychiatric diagnoses. For example, only 5·9 % fulfilled the criteria for clinical depression. Self-reported well-being (WHO-5, 71·09 (23·91)) and observer-rated functional ability (GAS/GAF, 81·76 (14·15)) were high. There were no significant differences in diagnosis prevalence by gender. However, significant differences existed between accompanied versus unaccompanied groups. Being an unaccompanied refugee individual was associated with a higher risk of suicidal thoughts, adjusted odds ratio, aOR 5·66 (95 % CI 2·15-14·88), higher rates of post-traumatic stress disorder symptoms β = 0·72 (0·39-1·05), lower mental well-being β = -10·86 95 % CI (-18·23- -3·48) and lower functional ability β = -9·38 (-13·84- -4·92). There were no differences in outcomes by gender except for worse well-being in males (β = 6·83 (1·01-12·66)).

Interpretation: In this sample, we found lower prevalence rates for all psychiatric diagnoses compared to earlier published studies. Being an unaccompanied refugee individual was a risk factor for all adverse outcomes. Future studies need to confirm the relatively low rates of psychiatric diagnoses. Regardless, the results highlight the heterogeneous needs among newly arrived refugees.

Background: Clinical guidelines remain unclear on which medications for gambling disorder are to be preferred in terms of efficacy and tolerability. We aimed to compare pharmacological treatments for gambling disorder in terms of efficacy and tolerability, using network meta-analysis (NMA).

Methods: Based on our pre-registered protocol [CRD42022329520], a structured search was conducted across broad range of databases, for double-blind randomized controlled trials (RCTs) of medications for gambling disorder. Data were independently extracted by two researchers. We used standardized mean differences (SMD) using Hedges' g to measure the efficacy outcomes, and for the effect for tolerability we used dropout rate due to medication side effects, expressed as odds ratio (OR). Confidence in the network estimates was assessed using the CINeMA framework. We followed the PRISMA-NMA guidelines for this work. Outcomes were gambling symptom severity and quality of life (for efficacy), and tolerability.

Findings: We included 22 RCTs in the systematic review and 16 RCTs (n = 977 participants) in the NMA. Compared with placebo, moderate confidence evidence indicated that nalmefene [Standardized Mean Difference (SMD): -0.86; 95 % confidence interval (CI: -1.32,-0.41)] reduced gambling severity, followed by naltrexone (SMD: -0.42; 95 %CI: (-0.85,0.01)). Naltrexone (SMD: -0.50; 95 %CI: (-0.85,-0.14)) and nalmefene (SMD: -0.36; 95 %CI: (-0.72,-0.01) were also more beneficial than placebo in terms of quality of life. Olanzapine and topiramate were not more efficacious than placebo. Nalmefene [Odds Ratio (OR): 7.55; 95 %CI: (2.24-25.41)] and naltrexone (OR: 7.82; 95 %CI: (1.26-48.70)) had significantly higher dropout due to side effects (lower tolerability) compared with placebo.

Interpretation: Based on NMA, nalmefene and naltrexone currently have the most supportive evidence for the pharmacological treatment of gambling disorder. Further clinical trials of novel compounds, and analysis of individual participant data are needed, to strengthen the evidence base, and help tailor treatments at the individual patient level.

Background: While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students.

Method: A total of 636 college students (80 % female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs.

Results: At baseline, the prevalence of IA and PLEs was 11.3 % and 16.8 %, respectively. Higher baseline IADQ scores (Adjusted odds ratio = 1.035; 95 % confidence interval = 1.002-1.069; p = 0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β = 0.082, p = 0.043), whereas baseline PLEs did not predict IA (β = 0.049, p = 0.255). Specifically, IA predicted unusual thoughts (β = 0.122, p = 0.003) and negative PLEs (β = 0.111, p = 0.008), but not perceptual abnormalities (β = 0.040, p = 0.301).

Conclusion: IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs.