Mirko Manchia, Alessandro Miola, Leonardo Tondo, Ross J. Baldessarini
Objectives
Recurrent [hypo]mania without major depressive episodes (“unipolar mania” [UPM]) is an uncommon form of major affective disorder related to bipolar disorder (BD). We characterized UPM patients and estimated the prevalence of their characteristics based on prolonged times-at-risk.
Methods
Using standard bivariate and multivariate statistics, we compared the characteristics of 63 consecutive UPM patients to 1210 other BD patients over prolonged, close, prospective follow-up at expert mood disorder centers.
Results
UPM was uncommon (4.95% of 1273 BD cases during 18.2 years at risk) with a 2.5-fold excess of men and 93.4% considered type I BD. UPM cases had earlier initial clinical interventions than other BD patients, more psychotic features with first episodes, and fewer UPM patients were married but did not have fewer children and were more unemployed. UPM cases experienced more morbidity (episodes and hospitalizations/year and %-time ill) than other BD patients and made more follow-up clinic visits/year. They were less likely to be suicidal and had less general medical comorbidity but did not differ in substance abuse. They had lower ratings of depressive symptoms, used mood stabilizers more, and as expected, received antidepressants 27 times less than other BD patients. Observed rates of UPM declined with longer observation times.
Conclusions
UPM was uncommon (4.95% of BD cases; 0.31% with hypomania only). Compared to ordinary BD, UPM had significantly greater morbidity and unemployment but a lower risk of suicidal behavior or general medical disorders associated with bipolar depression. This unusual disorder needs greater recognition, clarification of its nosological status, and efforts to optimize its treatment.
{"title":"Unipolar Mania: Prevalence and Patient Characteristics","authors":"Mirko Manchia, Alessandro Miola, Leonardo Tondo, Ross J. Baldessarini","doi":"10.1111/acps.13798","DOIUrl":"10.1111/acps.13798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Recurrent [hypo]mania without major depressive episodes (“unipolar mania” [UPM]) is an uncommon form of major affective disorder related to bipolar disorder (BD). We characterized UPM patients and estimated the prevalence of their characteristics based on prolonged times-at-risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using standard bivariate and multivariate statistics, we compared the characteristics of 63 consecutive UPM patients to 1210 other BD patients over prolonged, close, prospective follow-up at expert mood disorder centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>UPM was uncommon (4.95% of 1273 BD cases during 18.2 years at risk) with a 2.5-fold excess of men and 93.4% considered type I BD. UPM cases had earlier initial clinical interventions than other BD patients, more psychotic features with first episodes, and fewer UPM patients were married but did not have fewer children and were more unemployed. UPM cases experienced more morbidity (episodes and hospitalizations/year and %-time ill) than other BD patients and made more follow-up clinic visits/year. They were less likely to be suicidal and had less general medical comorbidity but did not differ in substance abuse. They had lower ratings of depressive symptoms, used mood stabilizers more, and as expected, received antidepressants 27 times less than other BD patients. Observed rates of UPM declined with longer observation times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>UPM was uncommon (4.95% of BD cases; 0.31% with hypomania only). Compared to ordinary BD, UPM had significantly greater morbidity and unemployment but a lower risk of suicidal behavior or general medical disorders associated with bipolar depression. This unusual disorder needs greater recognition, clarification of its nosological status, and efforts to optimize its treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"680-688"},"PeriodicalIF":5.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gestational exposure to valproate has been associated with a wide range of adverse pregnancy outcomes, including major congenital malformations in offspring. However, to date, no meta-analysis has comprehensively examined the risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children gestationally exposed to valproate.
Methods
We searched MEDLINE, Embase, and Scopus from inception until 15 May 2024 for relevant English-language articles. Primary outcomes of interest were the risk of ASD and ADHD, two independent primary outcomes, in children exposed to valproate anytime during pregnancy relative to unexposed children. Secondary outcomes were trimester-wise analyses of risk. We used a random effects model to pool the overall and trimester-wise hazard ratios (HRs) and obtained 95% confidence intervals (CIs), separately for the risks of ASD and ADHD. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist.
Results
Eight cohort studies (pooled N = 6,033,300) met our search criteria. Anytime gestational exposure to valproate was associated with a large increase in the risk of ASD (adjusted HR [aHR], 3.10; 95% confidence interval [CI], 2.24–4.28; N = 1,841,198) and a modest increase in the risk of ADHD (aHR, 1.62; 95% CI, 1.30–2.01; N = 24,295). The findings in sensitivity analyses for both outcomes were generally consistent with those of the main analyses. Notably, anytime gestational exposure to high-dose valproate (> 1.0 to 1.1 g/day) was associated with a substantially elevated risk of ASD (aHR, 6.32; 95% CI, 3.12–12.80, N = 1,719,825). Likewise, in monotherapy (aHR, 4.21; 95% CI, 2.97–5.95; N = 1,745,253) and discordant sibling pair (aHR, 6.42; 95% CI, 2.02–20.42; N = 1133) analyses, the risk of ASD was substantially elevated.
Conclusion
Gestational exposure to valproate was associated with an increased risk of ASD and ADHD; the risks for ASD were greater at doses ≥ 1000 mg/day. These findings add to the literature that strongly discourages the use of valproate by women of childbearing age, especially during pregnancy.
{"title":"Gestational Exposure to Valproate and Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder in Offspring: Systematic Review and Meta-Analysis","authors":"Chittaranjan Andrade, Natarajan Varadharajan, Sharmi Bascarane, Akshayee Kale, Jilisha Gnanadhas, Vikas Menon","doi":"10.1111/acps.13797","DOIUrl":"10.1111/acps.13797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gestational exposure to valproate has been associated with a wide range of adverse pregnancy outcomes, including major congenital malformations in offspring. However, to date, no meta-analysis has comprehensively examined the risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children gestationally exposed to valproate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase, and Scopus from inception until 15 May 2024 for relevant English-language articles. Primary outcomes of interest were the risk of ASD and ADHD, two independent primary outcomes, in children exposed to valproate anytime during pregnancy relative to unexposed children. Secondary outcomes were trimester-wise analyses of risk. We used a random effects model to pool the overall and trimester-wise hazard ratios (HRs) and obtained 95% confidence intervals (CIs), separately for the risks of ASD and ADHD. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight cohort studies (pooled <i>N</i> = 6,033,300) met our search criteria. Anytime gestational exposure to valproate was associated with a large increase in the risk of ASD (adjusted HR [aHR], 3.10; 95% confidence interval [CI], 2.24–4.28; <i>N</i> = 1,841,198) and a modest increase in the risk of ADHD (aHR, 1.62; 95% CI, 1.30–2.01; <i>N</i> = 24,295). The findings in sensitivity analyses for both outcomes were generally consistent with those of the main analyses. Notably, anytime gestational exposure to high-dose valproate (> 1.0 to 1.1 g/day) was associated with a substantially elevated risk of ASD (aHR, 6.32; 95% CI, 3.12–12.80, <i>N</i> = 1,719,825). Likewise, in monotherapy (aHR, 4.21; 95% CI, 2.97–5.95; <i>N</i> = 1,745,253) and discordant sibling pair (aHR, 6.42; 95% CI, 2.02–20.42; <i>N</i> = 1133) analyses, the risk of ASD was substantially elevated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gestational exposure to valproate was associated with an increased risk of ASD and ADHD; the risks for ASD were greater at doses ≥ 1000 mg/day. These findings add to the literature that strongly discourages the use of valproate by women of childbearing age, especially during pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"668-679"},"PeriodicalIF":5.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>As a medical discipline, psychiatry has long grappled with the concept of trust. While there are many reasons for this, it remains a contemporary issue for two of our most crucial treatments for treatment-resistant conditions: electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).</p><p>This lack of trust has translated into divergent and polarised patient and media narratives for ECT despite extensive evidence of its highly effective treatment [<span>1, 2</span>]. With increased understanding of mechanisms and sophistication of treatment, the clinical procedure of prescribing ECT is also becoming more challenging. As such, clinicians require growing trust in their ability to determine and, to some degree, predict which type of ECT (determined by lead placement, pulse width and stimulus dose in relation to threshold) is likely to lead to remission with additional consideration of obtaining a favourable side-effect profile [<span>3</span>]. For the practising ECT clinician, complexity increases where the specific use of anaesthetic and augmenting agents, selection of titration protocols and procedural timings need to be considered [<span>4</span>]. This is particularly important since the elements of ECT practice that require rating of features are often more impacted by the practitioner's experience level [<span>5</span>].</p><p>As we approach 40 years since its inception, the issue of trust in rTMS is less linked to stigma and external factors where it is easier to directly demonstrate modulation of neuronal activity, which the patient can observe. However, trust in selecting optimal treatment parameters remains a subject of intense research after all this time. Although the choices will sound similar (target site, pulses and number of sessions), the fundamental parameters considered, in addition to potential target brain structures, remain the same [<span>6</span>]. The issue is that for both life-saving treatments, there can be ambiguity around whether new patients should start ECT, rTMS or an alternative treatment like ketamine. Then, if they do, a number of optimal treatment parameters need to be decided by the clinician with limited ability to personalise this to the patient.</p><p>Plenty of lofty promises have been made about the potential of digital psychiatry. However, one of the biggest is to use machine-learning algorithms to step beyond the capabilities of traditional statistics and reveal connections that have previously not been apparent to us [<span>7</span>]. Despite the promise, machine learning has been criticised for not readily demonstrating to clinicians how individual factors influence the output, leading to a lack of transparency, understanding and mistrust from clinicians using them. This is particularly difficult when models are later demonstrated to have a negative impact, and the reasons cannot be thoroughly dissected. Furthermore, most precision psychiatry studies have remained pilo
{"title":"Can ECT and rTMS Finally Help Us Trust in Precision Psychiatry?","authors":"Robert M. Lundin","doi":"10.1111/acps.13795","DOIUrl":"https://doi.org/10.1111/acps.13795","url":null,"abstract":"<p>As a medical discipline, psychiatry has long grappled with the concept of trust. While there are many reasons for this, it remains a contemporary issue for two of our most crucial treatments for treatment-resistant conditions: electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).</p><p>This lack of trust has translated into divergent and polarised patient and media narratives for ECT despite extensive evidence of its highly effective treatment [<span>1, 2</span>]. With increased understanding of mechanisms and sophistication of treatment, the clinical procedure of prescribing ECT is also becoming more challenging. As such, clinicians require growing trust in their ability to determine and, to some degree, predict which type of ECT (determined by lead placement, pulse width and stimulus dose in relation to threshold) is likely to lead to remission with additional consideration of obtaining a favourable side-effect profile [<span>3</span>]. For the practising ECT clinician, complexity increases where the specific use of anaesthetic and augmenting agents, selection of titration protocols and procedural timings need to be considered [<span>4</span>]. This is particularly important since the elements of ECT practice that require rating of features are often more impacted by the practitioner's experience level [<span>5</span>].</p><p>As we approach 40 years since its inception, the issue of trust in rTMS is less linked to stigma and external factors where it is easier to directly demonstrate modulation of neuronal activity, which the patient can observe. However, trust in selecting optimal treatment parameters remains a subject of intense research after all this time. Although the choices will sound similar (target site, pulses and number of sessions), the fundamental parameters considered, in addition to potential target brain structures, remain the same [<span>6</span>]. The issue is that for both life-saving treatments, there can be ambiguity around whether new patients should start ECT, rTMS or an alternative treatment like ketamine. Then, if they do, a number of optimal treatment parameters need to be decided by the clinician with limited ability to personalise this to the patient.</p><p>Plenty of lofty promises have been made about the potential of digital psychiatry. However, one of the biggest is to use machine-learning algorithms to step beyond the capabilities of traditional statistics and reveal connections that have previously not been apparent to us [<span>7</span>]. Despite the promise, machine learning has been criticised for not readily demonstrating to clinicians how individual factors influence the output, leading to a lack of transparency, understanding and mistrust from clinicians using them. This is particularly difficult when models are later demonstrated to have a negative impact, and the reasons cannot be thoroughly dissected. Furthermore, most precision psychiatry studies have remained pilo","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"465-466"},"PeriodicalIF":5.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher B. Watson, Christopher F. Sharpley, Vicki Bitsika, Ian Evans, Kirstan Vessey
Introduction
Childhood maltreatment (CM) and depression are serious global issues with high prevalence and lifelong impacts on physical and mental health. CM has been proposed as a modifiable risk factor for depression that, if prevented, may contribute to a reduction in the global incidence of depressive disorders. Despite this, there is a paucity of reviews examining the strength of the association between these variables. The aim of this systematic review and meta-analysis was to evaluate the empirical evidence and determine if CM is supported as a preventable risk factor for depression.
Methods
A search was performed in July 2024 for all peer-reviewed journal articles written in English examining the relationship between CM and adult depression in the electronic databases EBSCOhost, Proquest, and Embase. Studies were included in this review if they measured maltreatment before 18 years of age as the independent variable and adult depression as the dependent variable. Studies were excluded if the outcome variable was grouped with comorbidity and if they did not report primary quantitative data. A total of 77 studies with 516,302 participants met the inclusion criteria for review.
Results
A random-effects meta-analysis was used to generate a pooled odds ratio from 87 effect estimates and demonstrated that individuals with a history of any CM are 2.5 times more likely to experience adult depression (OR = 2.49 [95% CI: 2.25–2.76]). This increase in odds remained regardless of how the primary studies screened for depression.
Conclusions
These findings confirmed the strong association between the experience of CM and adult depression. High heterogeneity in the meta-analytic results also suggested that further research is required that applies consistent adjustments for comorbidities and confounding factors and examines the temporal relationship between the variables to establish causality.
{"title":"A Systematic Review and Meta-Analysis of the Association Between Childhood Maltreatment and Adult Depression","authors":"Christopher B. Watson, Christopher F. Sharpley, Vicki Bitsika, Ian Evans, Kirstan Vessey","doi":"10.1111/acps.13794","DOIUrl":"10.1111/acps.13794","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Childhood maltreatment (CM) and depression are serious global issues with high prevalence and lifelong impacts on physical and mental health. CM has been proposed as a modifiable risk factor for depression that, if prevented, may contribute to a reduction in the global incidence of depressive disorders. Despite this, there is a paucity of reviews examining the strength of the association between these variables. The aim of this systematic review and meta-analysis was to evaluate the empirical evidence and determine if CM is supported as a preventable risk factor for depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was performed in July 2024 for all peer-reviewed journal articles written in English examining the relationship between CM and adult depression in the electronic databases <i>EBSCOhost</i>, <i>Proquest</i>, and <i>Embase</i>. Studies were included in this review if they measured maltreatment before 18 years of age as the independent variable and adult depression as the dependent variable. Studies were excluded if the outcome variable was grouped with comorbidity and if they did not report primary quantitative data. A total of 77 studies with 516,302 participants met the inclusion criteria for review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A random-effects meta-analysis was used to generate a pooled odds ratio from 87 effect estimates and demonstrated that individuals with a history of any CM are 2.5 times more likely to experience adult depression (<i>OR</i> = 2.49 [95% CI: 2.25–2.76]). This increase in odds remained regardless of how the primary studies screened for depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings confirmed the strong association between the experience of CM and adult depression. High heterogeneity in the meta-analytic results also suggested that further research is required that applies consistent adjustments for comorbidities and confounding factors and examines the temporal relationship between the variables to establish causality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"572-599"},"PeriodicalIF":5.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Paolini, Melania Maccario, Virginia Saredi, Anna Verri, Federico Calesella, Laura Raffaelli, Cristina Lorenzi, Sara Spadini, Raffaella Zanardi, Cristina Colombo, Sara Poletti, Francesco Benedetti
Introduction
Depressive disorders are a leading cause of global disease burden, particularly with the challenge of treatment-resistant depression (TRD). Research points to a complex bidirectional relationship between cardiovascular (CV) risk factors and TRD, with CV risk negatively impacting brain structure and potentially influencing antidepressant resistance. Moreover, the association between depression and the genetic vulnerability to cardiovascular disease suggests a shared pathophysiological process between the two. This study investigates the mediating role of brain structural alterations in the relationship between CV and cerebrovascular (CeV) risk and treatment resistance in depression.
Methods
We assessed 165 inpatients with Major depressive disorder. Each patient's CV risk was assessed via the QRISK 3 calculator. For a subset of patients, CV and CeV disease polygenic risk scores (PRS) were obtained. All patients underwent a 3 T MRI scan, and white matter hyperintensities estimates and indicators of brain trophic state were obtained.
Results
Both CV risk and CV disease PRSs are associated with treatment resistance status, white matter hyperintensities, and indicators of brain atrophy. Mediation analyses suggested that CV-induced brain alterations might underlie the relation between CV genetic and phenotypic risk and antidepressant treatment resistance.
Conclusion
These results underscore the need to explore cardiovascular risk management as part of treatment strategies for depression, pointing toward a shared pathophysiological process linking heart and brain health in treatment-resistant depression.
{"title":"Cardiovascular Risk Predicts White Matter Hyperintensities, Brain Atrophy and Treatment Resistance in Major Depressive Disorder: Role of Genetic Liability","authors":"Marco Paolini, Melania Maccario, Virginia Saredi, Anna Verri, Federico Calesella, Laura Raffaelli, Cristina Lorenzi, Sara Spadini, Raffaella Zanardi, Cristina Colombo, Sara Poletti, Francesco Benedetti","doi":"10.1111/acps.13793","DOIUrl":"10.1111/acps.13793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Depressive disorders are a leading cause of global disease burden, particularly with the challenge of treatment-resistant depression (TRD). Research points to a complex bidirectional relationship between cardiovascular (CV) risk factors and TRD, with CV risk negatively impacting brain structure and potentially influencing antidepressant resistance. Moreover, the association between depression and the genetic vulnerability to cardiovascular disease suggests a shared pathophysiological process between the two. This study investigates the mediating role of brain structural alterations in the relationship between CV and cerebrovascular (CeV) risk and treatment resistance in depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed 165 inpatients with Major depressive disorder. Each patient's CV risk was assessed via the QRISK 3 calculator. For a subset of patients, CV and CeV disease polygenic risk scores (PRS) were obtained. All patients underwent a 3 T MRI scan, and white matter hyperintensities estimates and indicators of brain trophic state were obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both CV risk and CV disease PRSs are associated with treatment resistance status, white matter hyperintensities, and indicators of brain atrophy. Mediation analyses suggested that CV-induced brain alterations might underlie the relation between CV genetic and phenotypic risk and antidepressant treatment resistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results underscore the need to explore cardiovascular risk management as part of treatment strategies for depression, pointing toward a shared pathophysiological process linking heart and brain health in treatment-resistant depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"709-718"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mette Reilev, Jacob Harbo Andersen, Mikkel Højlund, Elsebeth Stenager, Lotte Rasmussen, Erik Christiansen
Introduction
Changes in psychotropic drug use relative to suicidal behavior could potentially inform the timing of preventive efforts. We aimed to describe the initiation and discontinuation of psychotropic drugs relative to suicide and suicide attempts.
Methods
The Danish registries were used to describe incidents and prevalent use of psychotropic drugs 2 years before and after a suicide attempt and before suicide. Discontinuation of psychotropic drugs in the 6-month period prior to suicide and suicide attempts was estimated. Analyses were stratified by drug groups, sex, and age.
Results
Among 5.8 million Danish citizens(2021), 6374 died by suicide, and 29,332 had a first-ever suicide attempt from 2010 to 2021. Use of psychotropic drugs increased markedly in the 6 months prior to suicide and suicide attempt, e.g., up to 18 incident drug redemptions and 92 prevalent drug redemptions per 100 persons in the month before suicide. The highest rates of both incident and prevalent drug redemptions were observed immediately after the suicide attempt. Psychotropic drug use was generally lower among men. Immediately after the suicide attempt, however, men exhibited a slightly higher level of incident use than women. Ten percent discontinued psychotropic drugs completely in the 6-month period before suicide, while 48% discontinued drugs used in alcohol abuse.
Conclusion
We found a marked increase in psychotropic drug use before suicide and before and after attempted suicide. Complete pre-attempt discontinuation of psychotropic drugs was low, though approximately half discontinued drugs used for alcohol abuse. The process of prescribing psychotropic drugs may represent an opportunity for prevention.
{"title":"Initiation and Discontinuation of Psychotropic Drugs Relative to Suicidal Behavior: A Danish Registry-Based Study","authors":"Mette Reilev, Jacob Harbo Andersen, Mikkel Højlund, Elsebeth Stenager, Lotte Rasmussen, Erik Christiansen","doi":"10.1111/acps.13792","DOIUrl":"10.1111/acps.13792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Changes in psychotropic drug use relative to suicidal behavior could potentially inform the timing of preventive efforts. We aimed to describe the initiation and discontinuation of psychotropic drugs relative to suicide and suicide attempts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Danish registries were used to describe incidents and prevalent use of psychotropic drugs 2 years before and after a suicide attempt and before suicide. Discontinuation of psychotropic drugs in the 6-month period prior to suicide and suicide attempts was estimated. Analyses were stratified by drug groups, sex, and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5.8 million Danish citizens(2021), 6374 died by suicide, and 29,332 had a first-ever suicide attempt from 2010 to 2021. Use of psychotropic drugs increased markedly in the 6 months prior to suicide and suicide attempt, e.g., up to 18 incident drug redemptions and 92 prevalent drug redemptions per 100 persons in the month before suicide. The highest rates of both incident and prevalent drug redemptions were observed immediately after the suicide attempt. Psychotropic drug use was generally lower among men. Immediately after the suicide attempt, however, men exhibited a slightly higher level of incident use than women. Ten percent discontinued psychotropic drugs completely in the 6-month period before suicide, while 48% discontinued drugs used in alcohol abuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found a marked increase in psychotropic drug use before suicide and before and after attempted suicide. Complete pre-attempt discontinuation of psychotropic drugs was low, though approximately half discontinued drugs used for alcohol abuse. The process of prescribing psychotropic drugs may represent an opportunity for prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"698-708"},"PeriodicalIF":5.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamilla W. Miskowiak, Julian Macoveanu, Brice Ozenne, Emily E. Beaman, Vibeke H. Dam, Patrick M. Fisher, Gitte M. Knudsen, Lars V. Kessing, Martin B. Jørgensen, Vibe G. Frokjaer, Anjali Sankar
Introduction
Patients with mood disorders, especially, major depressive disorder (MDD) and bipolar disorder (BD), are at heightened risk of relapse and psychiatric rehospitalizations. Therefore, there is an urgent need to identify modifiable biomarkers to inform personalized and intensified prevention strategies for those at the greatest risk of relapse and hospital readmissions. Brain structural measures subserving cognitive function hold particular promise among potential predictive biomarkers.
Methods
In the present study, structural magnetic resonance imaging scans were obtained from 319 patients with BD (n = 241) or MDD (n = 78). [Correction added on 7 March 2025, after first online publication: In the preceding sentence, ‘MDD (n=241) or BD (n=78)’ has been changed to ‘BD (n=241) or MDD (n=78)’.] Longitudinal data on psychiatric hospitalization for up to 10 years were available from the Danish National population-based registers. Interhemispheric hippocampal asymmetry, a putative marker of cognitive function and brain reserve, was calculated for each patient. The association between hippocampal asymmetry and future psychiatric hospitalization was assessed using a cause-specific Cox regression model. Exploratory analyses, also using a cause-specific Cox model, assessed the association of prefrontal and hippocampal gray matter volume and whole-brain white matter volume with hospitalizations.
Results
The results indicated a negative association between rightward hippocampal asymmetry (i.e., left<right) and risk of future hospitalizations (HR = 0.90, corresponding to a 10-year risk reduction of 0.018 for a 1% increase in asymmetry, p = 0.040). Exploratory analysis indicated that a larger right hippocampus volume was associated with a reduced risk of hospitalization (HR = 0.18, p = 0.004) while a larger bilateral dorsolateral prefrontal volume (HR = 1.06, p = 0.01) was associated with an increased risk of hospitalization.
Conclusion
The findings suggest a role for hippocampal and, additionally, prefrontal morphological features in the risk of future psychiatric hospitalizations in mood disorders.
{"title":"Relation Between Brain Morphological Features and Psychiatric Hospitalization Risk in Major Depressive and Bipolar Disorders","authors":"Kamilla W. Miskowiak, Julian Macoveanu, Brice Ozenne, Emily E. Beaman, Vibeke H. Dam, Patrick M. Fisher, Gitte M. Knudsen, Lars V. Kessing, Martin B. Jørgensen, Vibe G. Frokjaer, Anjali Sankar","doi":"10.1111/acps.13790","DOIUrl":"10.1111/acps.13790","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients with mood disorders, especially, major depressive disorder (MDD) and bipolar disorder (BD), are at heightened risk of relapse and psychiatric rehospitalizations. Therefore, there is an urgent need to identify modifiable biomarkers to inform personalized and intensified prevention strategies for those at the greatest risk of relapse and hospital readmissions. Brain structural measures subserving cognitive function hold particular promise among potential predictive biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the present study, structural magnetic resonance imaging scans were obtained from 319 patients with BD (<i>n</i> = 241) or MDD (<i>n</i> = 78). [Correction added on 7 March 2025, after first online publication: In the preceding sentence, ‘MDD (n=241) or BD (n=78)’ has been changed to ‘BD (n=241) or MDD (n=78)’.] Longitudinal data on psychiatric hospitalization for up to 10 years were available from the Danish National population-based registers. Interhemispheric hippocampal asymmetry, a putative marker of cognitive function and brain reserve, was calculated for each patient. The association between hippocampal asymmetry and future psychiatric hospitalization was assessed using a cause-specific Cox regression model. Exploratory analyses, also using a cause-specific Cox model, assessed the association of prefrontal and hippocampal gray matter volume and whole-brain white matter volume with hospitalizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicated a negative association between rightward hippocampal asymmetry (i.e., left<right) and risk of future hospitalizations (HR = 0.90, corresponding to a 10-year risk reduction of 0.018 for a 1% increase in asymmetry, <i>p</i> = 0.040). Exploratory analysis indicated that a larger right hippocampus volume was associated with a reduced risk of hospitalization (HR = 0.18, <i>p</i> = 0.004) while a larger bilateral dorsolateral prefrontal volume (HR = 1.06, <i>p</i> = 0.01) was associated with an increased risk of hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest a role for hippocampal and, additionally, prefrontal morphological features in the risk of future psychiatric hospitalizations in mood disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"689-697"},"PeriodicalIF":5.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Perfalk, Martin Bernstorff, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard
Background
Clinical decision support systems based on machine learning (ML) models are emerging within psychiatry. To ensure their successful implementation, healthcare staff needs to trust these systems. Here, we investigated if providing staff with basic information about ML-based clinical decision support systems enhances their trust in them.
Methods
We conducted a randomised survey experiment among staff in the Psychiatric Services of the Central Denmark Region. The participants were allocated to one of three arms, receiving different types of information: An intervention arm (receiving information on clinical decision-making supported by an ML model); an active control arm (receiving information on standard clinical decision process without ML support); and a blank control arm (no information). Subsequently, participants responded to various questions regarding their trust/distrust in ML-based clinical decision support systems. The effect of the intervention was assessed by pairwise comparisons between all randomization arms on sum scores of trust and distrust.
Results
Among 2838 invitees, 780 completed the survey experiment. The intervention enhanced trust and diminished distrust in ML-based clinical decision support systems compared with the active control arm (Trust: mean difference = 5% [95% confidence interval (CI): 2%; 9%], p value < 0.001; Distrust: mean difference = −4% [−7%; −1%], p value = 0.042) and the blank control arm (Trust: mean difference = 5% [2%; 11%], p value = 0.003; Distrust: mean difference = −3% [−6%; −1%], p value = 0.021).
Conclusion
Providing information on ML-based clinical decision support systems in hospital psychiatry may increase healthcare staff trust in such systems.
{"title":"Receiving Information on Machine Learning-Based Clinical Decision Support Systems in Psychiatric Services Increases Staff Trust in These Systems: A Randomized Survey Experiment","authors":"Erik Perfalk, Martin Bernstorff, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard","doi":"10.1111/acps.13791","DOIUrl":"10.1111/acps.13791","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical decision support systems based on machine learning (ML) models are emerging within psychiatry. To ensure their successful implementation, healthcare staff needs to trust these systems. Here, we investigated if providing staff with basic information about ML-based clinical decision support systems enhances their trust in them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a randomised survey experiment among staff in the Psychiatric Services of the Central Denmark Region. The participants were allocated to one of three arms, receiving different types of information: An intervention arm (receiving information on clinical decision-making supported by an ML model); an active control arm (receiving information on standard clinical decision process without ML support); and a blank control arm (no information). Subsequently, participants responded to various questions regarding their trust/distrust in ML-based clinical decision support systems. The effect of the intervention was assessed by pairwise comparisons between all randomization arms on sum scores of trust and distrust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2838 invitees, 780 completed the survey experiment. The intervention enhanced trust and diminished distrust in ML-based clinical decision support systems compared with the active control arm (Trust: mean difference = 5% [95% confidence interval (CI): 2%; 9%], <i>p</i> value < 0.001; Distrust: mean difference = −4% [−7%; −1%], <i>p</i> value = 0.042) and the blank control arm (Trust: mean difference = 5% [2%; 11%], <i>p</i> value = 0.003; Distrust: mean difference = −3% [−6%; −1%], <i>p</i> value = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Providing information on ML-based clinical decision support systems in hospital psychiatry may increase healthcare staff trust in such systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 1","pages":"39-48"},"PeriodicalIF":5.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on “Recovery and Recurrence From Major Depression in Adolescence and Adulthood”","authors":"Amogh Verma, Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1111/acps.13789","DOIUrl":"10.1111/acps.13789","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"646-648"},"PeriodicalIF":5.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Gomes-da-Costa, I. Fernandéz-Pérez, R. Borras, et al., “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder,” Acta Psychiatrica Scandinavica 150, no. 4 (2024): 209–222.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
We apologize for this error.
S. Gomes-da-Costa， I. fernandsamz - psamez， R. Borras等，“素食对双相情感障碍有益吗？”饮食模式、运动和药物治疗与双相情感障碍代谢综合征和疾病进程的关系，《斯堪的纳维亚精神病学学报》150期。[4](2024): 209-222。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。我们为这个错误道歉。
{"title":"Correction to “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder”","authors":"","doi":"10.1111/acps.13788","DOIUrl":"10.1111/acps.13788","url":null,"abstract":"<p>S. Gomes-da-Costa, I. Fernandéz-Pérez, R. Borras, et al., “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder,” <i>Acta Psychiatrica Scandinavica</i> 150, no. 4 (2024): 209–222.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>We apologize for this error.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"550-553"},"PeriodicalIF":5.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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