Acta Psychiatrica Scandinavica最新文献

Background: Individuals with bipolar disorder (BPD) and schizophrenia (SCZ) are at increased risk for cardiovascular disease and have been reported to exhibit inflammatory activation. This study examined the link between systemic inflamm-ation and accelerated atherosclerosis, focusing on whether high-sensitivity C-reactive protein (hs-CRP) is associated with carotid intima-media thickness (cIMT) in these populations.

Methods: Physically healthy outpatients with bipolar I disorder or schizophrenia (DSM-5) as well as healthy controls, aged 20-60 years, were recruited to assess cIMT via high-resolution carotid ultrasound. Fasting venous blood samples were collected to measure levels of hs-CRP and lipid profiles on the day of ultrasonography. Clinical data were obtained from medical records and interviews.

Results: Patients with BPD (n = 111) and SCZ (n = 115) demonstrated significantly higher cIMT and hs-CRP levels compared to healthy controls (n = 84). In the BPD group, age, BMI, hs-CRP levels, duration of illness, and lithium daily dosage were identified as significant correlates of cIMT in bivariate analyses. In the multivariate analyses, hs-CRP levels were independently associated with increased cIMT after adjustment for age, body mass index, sex, and smoking habit, explaining 5.6% of the variance. In SCZ group, only age was significantly associated with cIMT. Smoking status and lipid profiles were not significantly associated with cIMT in either group.

Conclusions: Even physically healthy patients with BPD and SCZ exhibit accelerated atherosclerosis before geriatric age, reflected by increased cIMT. The association between hs-CRP and cIMT is observed in BPD, but not in SCZ, suggesting a greater role of chronic low-grade inflammation in BPD-related early vascular changes.

Introduction: Cognitive impairment is a core feature of mood disorders that contributes to reduced functioning and poorer prognosis, thereby emerging as an important treatment target. Persistent trait-related impairments present within both affective and non-affective cognition. Nevertheless, the relationship between affective and non-affective cognitive domains remains unclear, including whether impairments in emotion regulation and facial expression recognition are secondary to deficits in non-affective cognition. Mapping out the hierarchical structure of affective and non-affective cognitive domains may elucidate core cognitive impairments that represent the most relevant treatment targets.

Methods: Network analysis was employed to explore the associations between affective and non-affective cognitive domains in individuals with mood disorders (N = 380) and healthy controls (HC; N = 225) pooled from two previous studies. Partial correlation networks were constructed separately for individuals with mood disorders and HC comprising measures of non-affective cognition (working memory and executive function, attention and processing speed, verbal learning, and verbal memory) and affective cognition (emotion regulation success, facial expression recognition speed and accuracy).

Results: For both mood disorders and HC, 'working memory and executive function' and 'attention and processing speed' emerged as central cognitive domains. Emotion regulation showed a significantly weaker association with 'working memory and executive function' in mood disorders relative to HC. Additionally, facial expression recognition speed was associated with 'attention and processing speed' across both groups.

Conclusion: Our findings suggest that working memory, executive function, attention, and processing speed are core cognitive domains in mood disorders. Further, the weak association between executive function and emotion regulation in mood disorders may indicate a reduced reliance on cognitive control processes during emotion regulation. These findings underscore the importance of targeting both affective and non-affective cognition in pro-cognitive interventions to improve emotion regulation and potentially mitigate the risk of mood episodes.

Objective: Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to be an effective and well tolerated treatment for depression, and it is being investigated also for other indications. This study presents the Swedish National Quality Register for rTMS (Q-rTMS). The registry comprises epidemiological data, data from standardized rating scales, details on treatment settings, and a registry-specific patient questionnaire.

Methods: A presentation of the Q-rTMS including the types of data collected, the organizational structure of the register, as well as a brief overview of the volume of data accumulated between the registry's inception in 2018 and the end of 2024.

Results: As of 2024, the register contained data from a total of 3083 unique individuals and 3842 treatment series, collected from 27 different rTMS providers. The most common indication for rTMS was depression (International Classification of Diseases, Tenth Revision diagnoses (ICD-10): F32-F34, 74.1%) followed by bipolar affective disorder (ICD-10: F31, 14.2%). The average age was 43.2 years, and 56.5% were women. The register included matched pre- and post-treatment data exceeding 60% completeness for the Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), the Clinical Global Impression-Severity (CGI-S), and the EuroQol five-dimensional questionnaire (EQ-5D-5L).

Conclusion: The Q-rTMS combines high coverage with longitudinal documentation of clinically relevant outcome measures and may hence contribute to population-based real-world effectiveness research in rTMS for depression.

Introduction: Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes.

Methods: A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA.

Results: The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups.

Conclusions: Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.

Introduction: We aimed to synthesize the information relevant for clinical practice on involuntary clozapine treatment.

Methods: Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through September 2025 (PROSPERO database registration CRD420251234475). We included all articles addressing issues related to involuntary clozapine treatment irrespective of the route of administration, i.e., oral, intra-muscular (IM) or nasogastric. Data were synthesized narratively.

Results: Of the 29 identified articles, most clinical studies (n = 18) on people prescribed involuntary clozapine treatment (n = 236) were case reports/series or chart reviews. IM or nasogastric routes were the last-resort treatment for people with extremely severe psychotic disorders presenting with risky behavior. The decisional process was often lengthy due to the complex legal and ethical issues raised by involuntary treatment and restricted access to the unlicensed IM formulation. In nearly half of cases, the oral route was accepted after the decision to perform IM or nasogastric administration. Pain at the injection site was the most frequent adverse event after IM administration. Transition to this route occurred rapidly in the vast majority of the other cases, most often allowing a dramatic reduction in the severity of target symptoms and coercive measures. Clozapine was maintained orally after the acute phase in the majority of people with involuntary administration.

Conclusions: Although the body of evidence supporting the use of involuntary clozapine treatment is mostly drawn from small observational studies, their findings suggest that this last-resort option may save the life and promote recovery of people for whom other treatments have failed. Access to IM clozapine is currently restricted in most countries. Whether this barrier to clozapine treatment for severely ill people with impaired decision-making capacities should be overcome in other countries needs to be further addressed.

Registration: PROSPERO database registration CRD420251234475.

Introduction: Cognition is a common symptom dimension in major mood disorders and is associated with impairments in daily life functioning. Assessments that capture cognitive difficulties reflective of those that people experience in the real world are therefore much needed; however, most cognitive assessments lack ecological validity. A recently developed, fully immersive VR platform for cognitive assessment (CAVIR) has proven to be feasible, well-tolerated, sensitive to cognitive impairment in psychiatric populations, and associated with measures of daily functioning. Here we aimed to assess the validity of a newly developed English language version of CAVIR in people with primary mood disorders (PMD) and controls (HC).

Method: We enrolled 40 people with PMD including Bipolar I Disorder, Bipolar II Disorder, and Major Depressive Disorder, and 40 healthy controls. Participants were administered the CAVIR, the MATRICS Consensus Cognitive Battery (MCCB), symptom ratings, and measures of daily functioning (FAST, UPSA-B).

Results: Patients scored worse than controls on the CAVIR composite and all subtests (p = 0.02-p < 0.0001), except the executive functioning task (p = 0.85). Comparing the composite and domain scores of CAVIR to their corresponding domains on the MCCB revealed modest to moderate, significant correlations on the composite and all domains except executive functioning. The CAVIR was associated with both performance-based (UPSA-B) and interview rated (FAST) measures of functioning.

Conclusions: This newly translated English language version of CAVIR performed very similarly to the original version and was sensitive to cognitive impairments in people with PMD. CAVIR composite and most subtests were correlated with an established paper and pencil cognitive battery and were associated with measures of functioning. The CAVIR is self-administered, quick, and requires minimal training, making it a useful tool for assessing cognition.