Comprehensive psychiatry最新文献

英文中文

Inpatient vs outpatient cognitive behavioral therapy for insomnia: A two-arm parallel randomized controlled trial 失眠症的住院与门诊认知行为疗法：一项平行随机对照试验

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-23 DOI: 10.1016/j.comppsych.2025.152609

Guifeng Li , Mengya Li , Xin Xu , Junhong Zhang , Qifang Li , Qing Cai

Objective

While outpatient cognitive behavioral therapy for insomnia (CBT-I) represents the most efficacious delivery method, approximately 50 % of patients are unable to achieve clinical remission. There is a pressing need to develop more effective approaches to CBT-I delivery. This study assessed the comparative efficacy of one-week inpatient CBT-I and eight-week standard outpatient CBT-I.

Methods

A randomized controlled trial was conducted with 200 adults with chronic insomnia disorder. These participants were randomly allocated to either the inpatient group (n = 100) or the outpatient group (n = 100). The inpatient group underwent a one-week intensive inpatient CBT-I followed by weekly follow-ups program. The outpatient group participated in a standard outpatient CBT-I program conducted on an individual basis over an eight-week period. The primary outcome was the insomnia severity index score at 9 weeks after the start of intervention. Linear mixed effects model was employed for the intention-to-treat analysis.

Results

At the 9-week assessment, the inpatient CBT-I group demonstrated a mean change in insomnia severity index score of −13.31 (95 % confidence interval [CI], −14.47 to −12.16; Cohen's d = −3.18; P < .001). The outpatient group showed a mean change of −11.14 (95 % CI, −12.30 to −9.98; Cohen's d = −2.66; P < .001). The mean difference between groups was −2.03 (95 % CI, −3.21 to −0.85; Cohen's d = −0.48; P < .001), indicating a statistically significant improvement in the inpatient group compared to the outpatient group.

Conclusions

This study demonstrated that inpatient CBT-I exhibited superior efficacy compared to outpatient CBT-I in alleviating insomnia severity.

目的：虽然门诊认知行为治疗失眠（CBT-I）是最有效的治疗方法，但约50%的患者无法达到临床缓解。迫切需要制定更有效的CBT-I交付方法。本研究评估了住院1周的CBT-I和标准门诊8周的CBT-I的比较疗效。方法对200例成人慢性失眠症患者进行随机对照试验。这些参与者被随机分配到住院组（n = 100）或门诊组（n = 100）。住院组接受了为期一周的强化住院CBT-I，随后是每周的随访计划。门诊组参加了一个标准的门诊CBT-I项目，以个人为基础，为期八周。主要结果是干预开始后9周的失眠严重程度指数评分。意向-治疗分析采用线性混合效应模型。结果在9周的评估中，住院患者CBT-I组失眠严重程度指数得分的平均变化为- 13.31(95%置信区间[CI]， - 14.47至- 12.16；Cohen’s d =−3.18；P & lt;措施)。门诊组平均变化为- 11.14 (95% CI, - 12.30 ~ - 9.98；Cohen’s d =−2.66；P & lt;措施)。组间平均差异为- 2.03 (95% CI, - 3.21 ~ - 0.85；Cohen’s d = - 0.48；P & lt;.001)，表明住院组与门诊组相比有统计学上的显著改善。结论与门诊患者相比，住院患者CBT-I在减轻失眠严重程度方面表现出更强的疗效。

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引用次数: 0

Mapping psychiatric comorbidity network: A pilot multi-method weighted network analysis with a focus on key disorders 映射精神共病网络：一个试点多方法加权网络分析与重点疾病

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-23 DOI: 10.1016/j.comppsych.2025.152608

Yu Chang , Si-Sheng Huang , Wen-Yu Hsu , Yi-Chun Liu

Background

Psychiatric comorbidity is a prevalent phenomenon that imposes a significant burden on patients, healthcare systems, and society. However, current research on psychiatric comorbidity is often limited to single disorders or partial associations. This study aims to utilize network analysis methods to construct a psychiatric comorbidity network and explore the network structural characteristics under different network weight definitions.

Method

Based on the psychiatric outpatient data from Changhua Christian Hospital in Taiwan from January 1, 2016, to June 30, 2024, the ICD-10 diagnostic codes (F00-F99) of all patients that appeared at least three times were extracted. Three different comorbidity networks were constructed using co-occurrence counts, Jaccard index, and partial correlation coefficient estimated by the mixed graphical model (MGM) as the weights of the network edges. Network structure was analyzed using indicators such as degree centrality, modularity, and community detection.

Results

The dataset included 16,954 patients. The comorbidity frequency network showed that mood disorders (F34) and anxiety disorders (F41) had the highest weighted degree centrality. In the Jaccard coefficient network, the weighted degree centrality of developmental disorders (F8x) increased. The MGM network highlighted the central role of substance use disorders (F1x).

Conclusion

Our findings suggested the roles and interrelationships of different disease categories in the comorbidity network. The results provide new perspectives and data support for clinical practice and future research.

精神疾病共病是一种普遍现象，给患者、卫生保健系统和社会带来了沉重的负担。然而，目前对精神疾病共病的研究往往局限于单一疾病或部分关联。本研究旨在运用网络分析方法构建精神共病网络，探讨不同网络权重定义下的网络结构特征。方法根据台湾彰化基督教医院2016年1月1日至2024年6月30日的精神科门诊资料，提取出现至少3次的所有患者的ICD-10诊断码（F00-F99）。利用共现数、Jaccard指数和由混合图形模型（MGM）估计的偏相关系数作为网络边的权值，构建了三种不同的共病网络。使用度中心性、模块化和社区检测等指标分析网络结构。结果数据集包括16,954例患者。共病频率网络显示，情绪障碍（F34）和焦虑障碍（F41）的加权度中心性最高。在Jaccard系数网络中，发育障碍的加权度中心性（F8x）增加。米高梅网络强调了物质使用障碍的核心作用（F1x）。结论不同疾病类型在合并症网络中的作用和相互关系。研究结果为临床实践和今后的研究提供了新的视角和数据支持。

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引用次数: 0

Screening accuracy of the German version of the benzodiazepine self-report questionnaire 德文版苯二氮卓类自我报告问卷的筛选准确性

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-18 DOI: 10.1016/j.comppsych.2025.152607

M.W. Stratmann , J. Heeg , M. Härter , L. Kriston , U. Verthein , C. Lindemann

Background and aims

We aimed to assess the accuracy for the German version of the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ-GV) as a possible screening instrument for benzodiazepine or Z-drug substance use disorder.

Method

This study includes a convenience sample of adults who had used benzodiazepines or Z-drugs at least once in the last year. Participants were recruited through notice boards, social media, newspaper, and a digital health information platform. All participants answered the Bendep-SRQ-GV and were assessed for benzodiazepine or Z-drug substance use disorder using the Structured Clinical Interview for DSM-5 Disorders – Clinical Version. We performed receiver operating characteristics curve analyses and calculated the area under the curve (AUC).

Results

42 out of 60 participants fulfilled the criteria for benzodiazepine or Z-drug substance use disorder according to Structured Clinical Interview. AUCs varied among the 4 subscales of the Bendep-SRQ-GV: Problematic Use (0.893 [0.819–0.975]), Preoccupation (0.751 [0.609–0.892]), Lack of Compliance (0.804 [0.699–0.919]), Withdrawal (0.743 [0.622–0.864]) and Total Score (0.860 [0.762–0.963]). For Problematic Use and Total Score selected cut-offs (5.5 and 16.5) showed best results: sensitivity (83 % [71–93 %] and 79 % [67–90 %]), high specificity (83 % [61–100 %] and 83 % [67–100 %], positive predictive value (92 % [84–100 %] and 92 % [83–100 %]), and negative predictive value (68 % [54–85 %] and 63 % [50–77 %]).

Discussion

The subscale Problematic Use and the Total Score seem promising for detecting benzodiazepine or Z-drug substance use disorder in adults. Precise cut-offs should be determined with a larger sample. The Bendep-SRQ-GV could be of great value as a screening questionnaire in clinical settings, counselling sites, and for scientific purposes.

背景与目的本研究旨在评估德文版苯二氮卓类药物依赖自我报告问卷（bendeep - srq - gv）作为苯二氮卓类药物或z类药物使用障碍筛查工具的准确性。方法本研究选取在过去一年中至少使用过一次苯二氮卓类药物或z类药物的成年人作为方便样本。参与者是通过布告栏、社交媒体、报纸和数字健康信息平台招募的。所有参与者都回答了bendeep - srq - gv，并使用DSM-5障碍-临床版结构化临床访谈评估苯二氮卓类或z -药物物质使用障碍。进行受试者工作特征曲线分析，计算曲线下面积（AUC）。结果根据结构化临床访谈，60名参与者中有42人符合苯二氮卓类药物或z类药物使用障碍标准。bendeep - srq - gv量表的auc分别为：问题使用（0.893[0.819-0.975]）、关注（0.751[0.609-0.892]）、缺乏依从性（0.804[0.699-0.919]）、戒断（0.743[0.622-0.864]）和总分（0.860[0.762-0.963]）。对于有问题的使用和总分选择的截断值（5.5和16.5）显示出最佳结果：敏感性（83%[71 - 93%]和79%[67 - 90%]），高特异性(83%[61 - 100%]和83%[67 - 100%]，阳性预测值（92%[84 - 100%]和92%[83 - 100%]），阴性预测值（68%[54 - 85%]和63%[50 - 77%]）。问题使用量表和总分似乎有希望检测成人苯二氮卓类药物或z类药物使用障碍。精确的截止值应该用更大的样本来确定。bendeep - srq - gv可以作为临床环境、咨询场所和科学目的的筛查问卷，具有很大的价值。

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引用次数: 0

Mapping the pathway to anabolic-androgenic steroids (AAS) use 绘制合成代谢雄激素类固醇（AAS）使用途径

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-15 DOI: 10.1016/j.comppsych.2025.152602

Nora M. Laskowski , Christopher Zaiser , Roland Müller , Gerrit Brandt , Georgios Paslakis

This short communication introduces a model for the use of anabolic-androgenic steroids (AAS), with body dissatisfaction as the central factor, shaped by sociocultural, psychological, and behavioral influences. Media-driven body ideals, gender, and sexual orientation may significantly influence body image, while low self-esteem and certain personality traits also contribute to dissatisfaction. Disordered eating behaviors (DEB) and intense physical exercise act as indirect contributors, particularly in fitness communities, where “conventional” body modification methods (i.e., exercise and diet) may fail to meet internalized ideals.

The model highlights a vicious cycle: body dissatisfaction drives AAS use, which, in turn, worsens dissatisfaction. Social media amplify this cycle by promoting unrealistic standards, while marginalized groups, including LGBTQI+ populations, face additional pressures to conform to heteronormative beauty norms. The overlap between body dissatisfaction, DEB, and intense physical exercise underscores the need for nuanced research to disentangle these inferences.

The model predominantly reflects Western body ideals, limiting its applicability across cultures. Addressing body dissatisfaction through early interventions targeting both societal standards and individual vulnerabilities is critical. Also, approaches accounting for aspects of sex and gender diversity are essential to promote body acceptance and reduce the risk of AAS use and DEB.

这篇简短的交流介绍了一个使用合成代谢雄激素类固醇（AAS）的模型，以身体不满意为中心因素，受社会文化、心理和行为影响。媒体驱动的身体理想、性别和性取向可能会显著影响身体形象，而低自尊和某些人格特质也会导致不满意。饮食失调行为（DEB）和剧烈的体育锻炼是间接因素，特别是在健身社区，“传统”的身体改造方法（即运动和饮食）可能无法满足内在理想。该模型强调了一个恶性循环：对身体的不满推动了AAS的使用，而AAS的使用又加剧了对身体的不满。社交媒体通过推广不切实际的标准放大了这个循环，而包括LGBTQI+人群在内的边缘群体则面临着遵守异性恋标准的额外压力。身体不满意、DEB和高强度体育锻炼之间的重叠强调了细致的研究来解开这些推论的必要性。该模型主要反映了西方的身体理想，限制了它在不同文化中的适用性。通过针对社会标准和个人脆弱性的早期干预来解决身体不满是至关重要的。此外，考虑性别和性别多样性方面的方法对于促进身体接受和降低AAS使用和DEB的风险至关重要。

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引用次数: 0

Corrigendum to “Neural mechanism of non-adaptive cognitive emotion regulation in patients with non-suicidal self-injury” [Comprehensive Psychiatry Volume 133 (2024) 152487] 对“非自杀性自伤患者的非适应性认知情绪调节的神经机制”的更正[综合精神病学卷133(2024)152487]。

IF 4.2 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-13 DOI: 10.1016/j.comppsych.2025.152601

Nan Lang , Sichu Wu , Yuan Zhong , Wenkun Lei , Yiwen Xiao , Yaming Hang , Ya Xie , Zhangwei Lv , Yumin Zhang , Xinyao Liu , Minlu Liang , Congjie Zhang , Pei Zhang , Hua Yang , Yun Wu , Qiuyu Wang , Kun Yang , Jing Long , Yuan Liu , Suhong Wang , Chun Wang

引用次数: 0

The LEADING guideline: Reporting standards for expert panel, best-estimate diagnosis, and longitudinal expert all data (LEAD) methods 主要指南：专家小组报告标准，最佳估计诊断和纵向专家所有数据（LEAD）方法

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-13 DOI: 10.1016/j.comppsych.2025.152603

Veerle C. Eijsbroek , Katarina Kjell , H. Andrew Schwartz , Jan R. Boehnke , Eiko I. Fried , Daniel N. Klein , Peik Gustafsson , Isabelle Augenstein , Patrick M.M. Bossuyt , Oscar N.E. Kjell

Accurate assessments of symptoms and illnesses are essential for health research and clinical practice but face many challenges. The absence of a single error-free measure is currently addressed by assessment methods involving experts reviewing several sources of information to achieve a best-estimate assessment. This assessment method is called the Expert Panel method in medicine, and the Best-Estimate Diagnosis or Longitudinal Expert All Data (LEAD) method in psychiatry and psychology. However, due to poor reporting of the assessment methods, the quality of pro-claimed best-estimate assessments is typically difficult to evaluate, and when the method is reported, the reporting quality varies substantially. To tackle this gap, we have developed a reporting guideline following a four-stage approach: 1) drafting reporting standards accompanied by empirical evidence, which were further developed with a patient organization for depression, 2) incorporating expert feedback through a two-round Delphi procedure, 3) refining the guideline based on an expert consensus meeting, and 4) testing the guideline by i) having researchers test it and ii) applying it to previously published studies. The last step also provides evidence for the need for the guideline: 10–63 % (Mean 33 %) of the standards were not reported across thirty randomly selected published studies. The result is the LEADING guideline comprising 20 reporting standards in four groups: the Longitudinal design, the Appropriate data, the Evaluation – experts, materials and procedures, and the Validity group. We hope that the LEADING guideline will assist researchers in planning, conducting, reporting, and evaluating research aiming to achieve best-estimate assessments.

对症状和疾病的准确评估对健康研究和临床实践至关重要，但面临许多挑战。目前的评估方法是由专家审查几个信息来源，以实现最佳估计评估，以解决缺乏单一的无差错措施的问题。这种评估方法在医学上被称为专家小组方法，在精神病学和心理学上被称为最佳估计诊断或纵向专家所有数据（LEAD）方法。然而，由于对评估方法的不良报告，主张的最佳估计评估的质量通常难以评估，并且当报告方法时，报告质量会发生很大变化。为了解决这一差距，我们制定了一个报告指南，遵循四个阶段的方法：1)起草报告标准，并伴有经验证据，与抑郁症患者组织一起进一步发展，2)通过两轮德尔菲程序纳入专家反馈，3)根据专家共识会议完善指南，4)通过i)让研究人员测试它，ii)将其应用于先前发表的研究来测试指南。最后一步也为指南的必要性提供了证据：在随机选择的30项已发表的研究中，10 - 63%（平均33%）的标准没有报告。结果是LEADING指南，包括四组20个报告标准：纵向设计，适当的数据，评估专家，材料和程序，以及有效性组。我们希望LEADING指南将帮助研究人员计划、实施、报告和评估旨在实现最佳估计评估的研究。

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引用次数: 0

A comparative evaluation of 23 projects on mental health and wellbeing for veterans and first responders 对23个退伍军人和急救人员心理健康和福利项目进行比较评价

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-03 DOI: 10.1016/j.comppsych.2025.152599

S. Lukersmith , C. Woods , L. Salvador-Carulla , T. Niyonsenga , I. Mohanty , M.R. Gutierrez-Colosia , D. Diaz-Milanes , C.R. Garcia-Alonso , C.J. Büsst

Background

Veterans and First Responders (VFR) are at risk of developing a range of mental health disorders because of cumulative exposure to critical incidents at work. Two Philanthropic organisations funded 15 organisations, which collectively implemented 23 highly heterogeneous and international early intervention mental ill-health and suicide prevention Projects. The aim was identify and collaborate with Projects with a multi-project evaluation. The evaluation examined multiple domains including intervention effectiveness but critically the implementation processes impacts for potential replication or scale up. This paper reports on the methods and evaluation results of implementation processes, impact analysis and sustainability.

Method

The evaluation involved ecosystems and complex systems approaches using novel methods and tools. There was multiple preparatory evaluation steps including developing indices for complexity and context. The Global Impact Analytics Framework (GIAF) toolkit was used to evaluate the implementation processes. Methodological tools included qualitative analysis, descriptive statistics, GIAF ladders/scales and checklists (qualitative and quantitative data).

Results

We provide the results on characteristics (organisational, Project and participants), GIAF process components (planning, pre-engagement, pre-readiness/readiness, dissemination/diffusion, usability/sustainability, adoption and uptake). All Project interventions were assessed as usable, adoptable and have capacity to be sustained, with financial resources. Uptake of the intervention was mostly high.

Conclusion

Complex multi-project evaluation of highly heterogenous Projects implemented in the real world across different countries is possible and provides valuable information and learnings. The evaluation results establish benchmarks including Project pre-engagement with potential end-users, continuous, frequent collaboration between Project and evaluation teams, adequate contract duration for sufficient recruitment and intervention.

退伍军人和急救人员（VFR）由于长期暴露于工作中的重大事件，有患一系列精神健康障碍的风险。两个慈善组织资助了15个组织，这些组织共同实施了23个高度多样化的国际早期干预精神疾病和自杀预防项目。其目的是通过多项目评估确定项目并与项目合作。评估审查了多个领域，包括干预有效性，但关键是实施过程对潜在复制或扩大规模的影响。本文报告了实施过程、影响分析和可持续性的方法和评价结果。方法采用新颖的方法和工具，对生态系统和复杂系统进行评价。有多个预备评价步骤，包括制定复杂性和背景指标。全球影响分析框架（GIAF）工具包用于评估实施过程。方法工具包括定性分析、描述性统计、GIAF阶梯/量表和核对表（定性和定量数据）。我们提供了关于特征（组织、项目和参与者）、GIAF过程组件（计划、预参与、预准备/准备、传播/扩散、可用性/可持续性、采用和吸收）的结果。所有项目干预措施都被评估为可用、可采用和有能力在财政资源的情况下持续下去。大多数人对干预措施的接受程度很高。结论对现实世界中不同国家实施的高度异质项目进行复杂的多项目评估是可能的，并提供了有价值的信息和学习。评估结果建立了基准，包括项目与潜在最终用户的预先接触，项目和评估团队之间持续、频繁的合作，为充分的招聘和干预提供足够的合同期限。

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引用次数: 0

Obsessive-compulsive spectrum disorders and the menstrual cycle: A scoping review 强迫性谱系障碍和月经周期：范围综述

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-01 DOI: 10.1016/j.comppsych.2024.152554

Juliette S. Mojgani , Anna M. Rzepka , Yejin Kang , Hashim Al-Bya , Beth Patterson , Michael Van Ameringen

引用次数: 0

Immuno-moodulin (Imood) and its potential role in OCD 免疫调节素（Imood）及其在强迫症中的潜在作用

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-01 DOI: 10.1016/j.comppsych.2024.152550

Fulvio D'Acquisto

引用次数: 0

Association of dimension-specific stressful life events with obsessive-compulsive disorder compared to social anxiety disorder 特定维度压力生活事件与强迫症与社交焦虑障碍的关联

IF 4.3 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry

Pub Date : 2025-05-01 DOI: 10.1016/j.comppsych.2024.152558

V. Hühne , S. dos Santos-Ribeiro , M.E. Moreira-de-Oliveira , L.D. Laurito , C.P. Loureiro , G.B. de Menezes , L.F. Fontenelle

引用次数: 0

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