Acta Psychiatrica Scandinavica最新文献

Introduction: Antenatal corticosteroid treatment (ACS), administered intramuscularly to pregnant women, is recommended as standard care when birth before 34 weeks of gestational age is anticipated. ACS is widely recognized for its ability to reduce neonatal mortality and morbidity, but it may affect maternal mental health due to its neuropsychiatric side effects and its timing during a period of heightened psychological vulnerability. Despite this, the potential association between ACS and maternal postpartum psychiatric disorders remains understudied. This study aimed to examine the possible associations between ACS and maternal postpartum depression and other postpartum psychiatric disorders.

Methods: This register-based cohort study included 165,936 births by 130,235 unique women at seven Danish hospitals between 2003 and 2018. Data on ACS administration, pregnancies, births, postpartum psychiatric disorders, and potential confounders were retrieved from Danish registers. The women were followed 1 year after giving birth for incident psychiatric disorders, and associations with ACS were explored in Cox proportional hazards regression models. The models were clustered by maternal ID and adjusted for sociodemographic, obstetric, and psychiatric covariates to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). An interaction between gestational age and ACS exposure was included in all models.

Results: Women who had been exposed to ACS but gave birth at term or post-term had significantly higher hazards of postpartum depression, other postpartum psychiatric disorders, and the combined outcome compared with non-exposed women giving birth at similar gestational ages, with HRs: 1.66 (1.18-2.33), 1.50 (1.03-2.19), and 1.64 (1.24-2.18), respectively. In contrast, associations among women who gave birth preterm were not statistically significant.

Conclusion: ACS exposure was associated with increased risks of maternal postpartum psychiatric disorders among women who gave birth term or post-term, but not among those who gave birth preterm. The increased risks in the term/post-term group are likely attributable to unmeasured confounding. These findings provide reassurance that ACS is unlikely to substantially increase the risk of postpartum psychiatric disorders among women delivering preterm, but they also highlight the need for attentive follow-up of women with threatened preterm labor who ultimately give birth at term. Our results also call for improved registration of ACS administration to strengthen future surveillance and drug safety.

Background: The mortality gap between people with mental disorders and the general population is well established. This study aims to comprehensively investigate how mortality rates for people with mental disorders and their mortality gap have changed over time.

Methods: We conducted a population-based cohort study using nationwide administrative data, including all people aged 1-99 years living in Denmark at some point between 2010 and 2023. Mental disorders were identified in the Danish hospital registers and classified into 10 groups. Information on mortality was obtained from population registers, and causes of death were categorized into 11 groups within the broad categories of natural causes and external causes. For each specific mental disorder, we estimated mortality rates for those diagnosed and for the general population via direct standardization using the distribution of sex and age (5-year age categories) of those diagnosed. All analyses were performed for five calendar periods (2010-2012, 2013-2015, 2016-2018, 2019-2021, and 2022-2023).

Results: A total of 7,133,833 individuals were followed up for 78.0 million person-years. The mortality rate for 2010-2023 for individuals with mental disorders was 19.8 deaths (95% CI: 19.8-19.9) per 1000 person-years, while the standardized mortality ratio (SMR) was 2.15 (2.14-2.16). Mortality rates decreased for both the general population and those with mental disorders over time, while SMRs decreased from 2.47 (2.44-2.50) in 2010-2012 to 2.32 (2.28-2.36) in 2022-2023. However, these improvements were only observed in males, and only for some disorders (including depression and anxiety), and not for others (including schizophrenia or substance use disorders).

Discussion: Despite improvements in the mortality rates of people with mental disorders, these have not been sufficient to close the mortality gap with the general population, especially for the most severe disorders. More initiatives are needed and existing initiatives need to be strengthened.

Introduction: Posttraumatic stress disorder (PTSD) is a mental disorder resulting from exposure to traumatic events. Evidence suggests that ketamine may be efficacious in treating PTSD, however, ketamine's mechanisms in treating PTSD remain unclear. Herein, this review aims to evaluate the clinical outcomes of ketamine treatment in persons with PTSD and investigate the possible neurobiological mechanisms underlying ketamine's therapeutic effect in PTSD.

Methods: A systematic search was conducted on PubMed and OVID (MEDLINE, Embase, PsychINFO) from inception until September 2025. Randomized controlled trials reporting on the effects of intravenous ketamine to treat PTSD were included.

Results: Seven studies with a total of 323 participants were included in this review. Ketamine administration meaningfully improved PTSD symptoms in two trials as evidenced by significant improvement on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Impact of Event Scale-Revised (IES-R) compared to control/placebo. Multi-infusion administration schedules achieved greater clinical outcomes when compared to single-dose administration schedules. Preliminary evidence suggests that repeated lower doses (0.2mg/kg) of ketamine were more efficacious in sustaining treatment effects than standard doses (0.5mg/kg). For persons receiving ketamine, an association was observed between top-down inhibition of the amygdala originating in the ventromedial prefrontal cortex (vmPFC) and symptom improvement.

Conclusion: Our results suggest that intravenous ketamine may be efficacious in the treatment of PTSD. Subsequent studies should attempt to evaluate the additive effect of combining ketamine with psychotherapeutic interventions as well as determining mechanistic pathways mediating symptom relief in persons with PTSD.

Introduction: Psychotic symptoms are frequent during acute episodes of bipolar disorder (BD), particularly in mania, and are traditionally considered a marker of greater severity and worse prognosis. However, data comparing psychotic and nonpsychotic mania remain limited and inconsistent.

Objectives: This study aimed to retrospectively examine clinical, therapeutical and 3-year outcome differences between patients hospitalized for mania with and without psychotic symptoms.

Methods: We included all patients admitted for a manic episode to the acute psychiatry unit at Hospital Clínic of Barcelona between 2015 and 2019 (n = 277). Data were extracted from medical records. Patients were followed for 3 years to assess psychiatric emergency department (PED) visits and readmissions. Functional outcomes were also analyzed in the BD subgroup (n = 234). Descriptive statistics and survival analyses were used.

Results: Psychotic symptoms were present in 73.6% of the patients and were associated with younger age (p < 0.001), earlier onset (p = 0.020), poorer insight (p < 0.001), higher cannabis use (p = 0.018) and manic predominant polarity (p = 0006). Non-psychotic patients had more previous admissions for depressive episodes (p = 0.003), more previous mixed episodes (p = 0.006) and suicide attempts (p = 0.002). No significant differences were found in PED visits or readmissions in the next 3 years. Logistic regression identified the number of previous mixed-episode-related admissions as a significant predictor of readmissions (p = 0.041), while psychotic symptoms were not associated with either outcome.

Conclusions: While psychotic and non-psychotic mania show clinical and therapeutical differences, psychosis may not predict short- to medium-term outcomes. Non-psychotic mania-which is associated with depressive polarity, mixed features and suicidal behaviour-may indicate a clinically relevant and therapeutically challenging but underrecognized subgroup. These findings call for a nuanced comprehension of the impact of psychosis in mania and multidimensional approaches.

Introduction: Robust evidence associates immunoinflammatory dysfunction and bipolar disorder (BD), with immune dysregulation present in patients newly diagnosed with BD. This suggests that anti-inflammatory agents, like low-dose aspirin (LDA), might be repurposed in the treatment of early-stage BD. Building on pharmacoepidemiologic and meta-analytic evidence, we conducted the first randomised controlled trial (RCT) testing the effects of add-on LDA in patients with newly diagnosed BD. We hypothesised that add-on treatment with LDA would reduce mood instability (MI), activity instability (AI), and depression severity.

Methods: In this parallel group, triple-blind, superiority RCT, patients newly diagnosed with BD, recruited from a public outpatient mood disorder clinic in the Capital Region of Denmark, were randomised 1:1 to 150 mg acetylsalicylic acid or placebo by an independent third party. The primary outcome was average MI at 6-month follow-up, assessed by the Root Mean Square of Successive Differences (RMSSDs) method. Secondary outcomes included average AI, assessed by the RMSSD method, and change in depressive symptoms, assessed with the 6-item Hamilton Depression Rating Scale, at 6 months. Tertiary outcomes included sleep variability, cognition, manic symptoms and questionnaires at 6 months.

Results: Two hundred fifty patients were randomised from January 20, 2022, to May 30, 2024, with the last follow-up on November 18, 2024. Analyses included data from 240 patients (120 received placebo; 120 LDA), with a mean of 108 (SD = 57) daily mood registrations. The estimated treatment difference for MI was 0.022 (95% CI: -0.056 to 0.1, p = 0.58) for LDA compared to placebo, indicating no clinically relevant difference. No beneficial effects of LDA were found across secondary or tertiary outcomes. Methodologically, randomisation and blinding were successful, and serum-thromboxane B2 levels confirmed high adherence to LDA.

Conclusions: Low-dose aspirin did not demonstrate any benefit on MI or on secondary or tertiary outcomes in patients with newly diagnosed BD.

Clinical registration: Clinicaltrials.gov registration number: NCT05035316.

Purpose: People with severe mental disorders (SMD) face a significantly lower life expectancy compared to people without SMD. Studies have reported divergent results concerning cancer-specific mortality. Therefore this systematic review and meta-analysis aimed to assess the cancer-specific mortality for people with preexisting SMD.

Methods: A comprehensive literature search was conducted across PubMed, Embase, Psycinfo, and Scopus for studies published since January 2003. Inclusion criteria targeted adult cancer patients with a known SMD diagnosis prior to their cancer diagnosis. Two authors independently screened records based on predefined criteria, resolving discrepancies through discussion. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale. A random effects model was employed to conduct the analysis, with heterogeneity across the studies quantified using the I² statistic.

Results: The search yielded 4736 records, of which 25 studies met the eligibility criteria. Findings consistently indicated higher cancer-specific mortality among patients with preexisting SMD, with a 1.37 (95% CI: 1.30-1.44) higher relative risk of cancer-specific mortality for patients with preexisting SMD. The highest mortality rates were found among patients with schizophrenia and other psychosis with a relative cancer mortality risk at 1.47 (95% CI: 1.33-1.63).

Conclusion: This review and meta-analysis highlighted a concerning higher relative cancer-specific mortality risk for patients with preexisting SMD. These findings underscore the need for integrated healthcare approaches addressing both cancer treatment and mental health to improve outcomes for this vulnerable population.

Background: Antipsychotics are widely used for neuropsychiatric symptoms (NPSs) in dementia including Alzheimer's disease (AD), yet balancing efficacy and safety remains a major clinical challenge.

Methods: Relevant randomized controlled trials were identified through a comprehensive literature search of CENTRAL, PubMed, CINAHL, and ClinicalTrials.gov. We conducted a dose-response model-based network meta-analysis to evaluate the efficacy as the change in overall NPS severity and the tolerability as treatment discontinuation due to adverse events of aripiprazole, brexpiprazole, risperidone, quetiapine and olanzapine at varying doses in patients with dementia including AD.

Results: Twenty trials involving 5844 participants were included. Most of the included antipsychotics exhibited a generally positive dose-response relationship with respect to both efficacy and tolerability, except for olanzapine, which showed a bell-shaped curve in terms of efficacy. Only aripiprazole 10 mg, brexpiprazole 1-2.5 mg, risperidone 1-2 mg, and olanzapine 2.5-5 mg were significantly more effective than placebo. Tolerability did not significantly decrease compared to placebo for aripiprazole up to 10 mg, brexpiprazole up to 3 mg, risperidone up to 1 mg, olanzapine up to 2.5 mg and at 15 mg, and quetiapine up to 200 mg. Furthermore, significant differences in efficacy and tolerability were observed between certain doses of several antipsychotics.

Conclusions: Aripiprazole 10 mg, brexpiprazole 1-2.5 mg, risperidone 1 mg, and olanzapine 2.5 mg were both effective and well tolerated, indicating their potential as favorable treatment options. As the present model incorporates several sources of uncertainty, its findings should be interpreted with caution and regarded as a provisional framework to support clinical decision-making.

Introduction: Millions of people have served in the Armed Forces of Ukraine (AFU) since Russia's invasion in 2014, but there is currently no information about the prevalence of posttraumatic stress disorder (PTSD) in this population. The main purpose of this study was to estimate rates of ICD-11 PTSD and Complex PTSD (CPTSD), and comorbidity with major depression, in a sample of active-duty, combat-exposed AFU military personnel.

Methods: Clinical interviews were conducted with 590 soldiers recruited from military hospitals and rehabilitation centers in Ukraine. All were trauma-exposed during military operations. PTSD and CPTSD were diagnosed using the International Trauma Interview, and a current episode of major depression was diagnosed using the Mini-International Neuropsychiatric Interview.

Results: Overall, 67.4% of soldiers were diagnosed with ICD-11 PTSD or CPTSD, with 45.9% being diagnosed with PTSD and 21.5% with CPTSD. Additionally, 34.4% were diagnosed with major depression, and comorbidity with PTSD (45.0%) and CPTSD (51.2%) was high. Elevated rates of PTSD were observed for current smokers and those who were currently consuming alcohol, while elevated rates of CPTSD were observed for officers (versus enlisted soldiers) and those recruited from rehabilitation facilities (vs. general hospitals).

Conclusion: Although not representative of the entire AFU population, these results imply that hundreds of thousands of soldiers (and veterans) in Ukraine are likely experiencing clinically significant posttraumatic distress related to their combat experiences. Results are discussed in the context of finding scalable approaches to addressing this mental health challenge.