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Mirtazapine in pregnancy and lactation: A systematic review of adverse outcomes. 妊娠期和哺乳期的米氮平:不良后果的系统回顾。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-31 DOI: 10.1111/acps.13749
Anne Ostenfeld, Sofie Lyngholm, Sarah Emilie Christensen, Tonny Studsgaard Petersen, Jon Trærup Andersen, Hanne Brix Westergaard, Lars Henning Pedersen, Ellen Christine Leth Løkkegaard

Introduction: Peripartum depression is common and treatment with mirtazapine may be indicated. However, evidence on its safety in pregnancy and lactation is fragmented. The objective of this systematic review was to evaluate the literature on the safety of mirtazapine in pregnancy and lactation.

Methods: PubMed, Embase, Medline, PsycInfo, and clinicaltrials.gov were searched for 'antidepressants' or 'mirtazapine' in combination with 'pregnancy', 'lactation' or 'offspring'. No restrictions on type of study were applied and selection was performed by two independent reviewers using Covidence. Two reviewers extracted data and performed risk of bias assessment and evidence synthesis was performed for each outcome individually. The protocol was registered at PROSPERO (registration number CRD42021275127).

Results: The initial search yielded 15,380 articles after removal of duplicates. After screening based on title and abstract, 431 articles remained for full text review. Of these, 41 studies were included (15 cohort studies, one case-control study, 11 case series, and 14 case reports). In most studies, the outcomes in mirtazapine-exposed pregnancies were comparable to controls. However, results on congenital malformations and spontaneous abortion were conflicting. Neonatal adaptation syndrome was reported after mirtazapine exposure in late pregnancy. Data on mirtazapine exposure during lactation were scarce.

Conclusions: We identified no substantial evidence indicating that mirtazapine exposure is associated with adverse outcomes in pregnancy or in offspring, other than neonatal adaptation syndrome. However, overall quality of evidence was low, and results on congenital malformations and spontaneous abortions were conflicting. Data on mirtazapine exposure through breastfeeding were limited and did not allow for conclusions.

简介围产期抑郁症很常见,可能需要使用米氮平进行治疗。然而,有关其在妊娠期和哺乳期安全性的证据并不完整。本系统综述旨在评估有关米氮平在妊娠期和哺乳期安全性的文献:方法:在 PubMed、Embase、Medline、PsycInfo 和 clinicaltrials.gov 中搜索 "抗抑郁药 "或 "米氮平",并结合 "妊娠"、"哺乳 "或 "后代"。研究类型不受限制,由两名独立审稿人使用 Covidence 进行筛选。两名审稿人提取数据并进行偏倚风险评估,对每项结果分别进行证据综合。研究方案已在 PROSPERO 注册(注册号为 CRD42021275127):在去除重复文章后,初步检索共获得 15,380 篇文章。根据标题和摘要进行筛选后,剩下 431 篇文章进行全文检讨。其中,41 项研究被纳入其中(15 项队列研究、1 项病例对照研究、11 项病例系列研究和 14 项病例报告)。在大多数研究中,暴露于米氮平的孕妇的结果与对照组相当。然而,关于先天性畸形和自然流产的结果却相互矛盾。有报告称,在妊娠晚期接触米氮平后会出现新生儿适应综合征。有关哺乳期接触米氮平的数据很少:除新生儿适应综合征外,我们没有发现任何实质性证据表明暴露于米氮平与妊娠期或后代的不良结局有关。然而,证据的总体质量较低,有关先天性畸形和自然流产的结果相互矛盾。通过母乳喂养接触米氮平的数据有限,无法得出结论。
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引用次数: 0
Psychosis metabolic risk calculator (PsyMetRiC) in early psychosis: External validation study in Finland. 早期精神病代谢风险计算器(PsyMetRiC):芬兰外部验证研究。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-29 DOI: 10.1111/acps.13752
Jaakko Keinänen, Saana Eskelinen, Tiina From, Heikki Laurikainen, Jarmo Hietala, Graham K Murray, Jaana Suvisaari, Benjamin I Perry

Introduction: Accurate detection of cardiometabolic risk in early psychosis is crucial to reducing somatic morbidity and mortality in people with psychotic disorders. We conducted an external validation of the psychosis metabolic risk calculator (PsyMetRiC), a cardiometabolic risk prediction tool developed in the UK and tailored for young people with psychosis. We compared the predictive accuracy and clinical usefulness of PsyMetRiC and a general population-based risk prediction tool for type 2 diabetes, the Finnish Diabetes Risk Score (FINDRISC).

Methods: We included first-episode psychosis and ultra-high-risk for psychosis patients without metabolic syndrome aged 18-35 years from the Helsinki Early Psychosis and Turku Early Psychosis Study cohorts. We tested two versions of PsyMetRiC: the full model including age, sex, ethnicity, body-mass index, smoking status, prescription of metabolically-active antipsychotic medication, high-density lipoprotein, and triglyceride concentrations, and the partial-model excluding biochemical predictors, and the simplified FINDRISC including BMI, sex, systolic blood pressure, and fasting glucose. Discrimination, calibration, and decision curve analyses were used to assess the predictive performance and clinical usefulness of both PsyMetRiC and FINDRISC. We performed a site-specific re-calibration of PsyMetRiC (PsyMetRiC-Fi).

Results: The study sample consisted of 278 individuals (all White European ethnicity, 58.6% male, mean age 24.8 years, 37.8% smoking, mean BMI 23.5). Discrimination was marginally better in the PsyMetRiC full model (C = 0.72, 95% CI, 0.59-0.82) compared with partial model (C = 0.70, 95% CI 0.59-0.80) or FINDRISC (C = 0.63, 95% CI 0.54-0.71). Calibration plots displayed evidence of minor miscalibration for PsyMetRiC, which corrected following recalibration. Miscalibration was more pronounced for FINDRISC. Decision curve analysis showed that PsyMetRiC offers likely clinical usefulness in improving cardiometabolic risk management in early psychosis compared with giving everyone or no one an intervention.

Conclusion: PsyMetRiC has utility in predicting cardiometabolic risk in Finnish patients with early psychosis. It has better discriminatory accuracy and offers more accurate risk prediction compared to other available strategies.

导言:准确检测早期精神病患者的心脏代谢风险对于降低精神病患者的躯体发病率和死亡率至关重要。我们对精神病代谢风险计算器(PsyMetRiC)进行了外部验证,该计算器是英国开发的一种心脏代谢风险预测工具,专为患有精神病的年轻人量身定制。我们比较了 PsyMetRiC 和基于普通人群的 2 型糖尿病风险预测工具芬兰糖尿病风险评分(FINDRISC)的预测准确性和临床实用性:我们的研究对象包括赫尔辛基早期精神病研究队列和图尔库早期精神病研究队列中年龄在18-35岁之间、无代谢综合征的首发精神病患者和超高危精神病患者。我们测试了两个版本的 PsyMetRiC:包括年龄、性别、种族、体重指数、吸烟状况、代谢活性抗精神病药物处方、高密度脂蛋白和甘油三酯浓度在内的完整模型和排除生化预测因子的部分模型,以及包括体重指数、性别、收缩压和空腹血糖在内的简化 FINDRISC。我们使用辨别、校准和决策曲线分析来评估 PsyMetRiC 和 FINDRISC 的预测性能和临床实用性。我们对 PsyMetRiC(PsyMetRiC-Fi)进行了特定地点的重新校准:研究样本包括 278 人(均为欧洲白人,58.6% 为男性,平均年龄 24.8 岁,37.8% 吸烟,平均体重指数 23.5)。与部分模型(C = 0.70,95% CI 0.59-0.80)或 FINDRISC(C = 0.63,95% CI 0.54-0.71)相比,PsyMetRiC 完全模型(C = 0.72,95% CI,0.59-0.82)的识别率略高。校准图显示 PsyMetRiC 存在轻微的校准误差,在重新校准后得到纠正。FINDRISC 的误校正更为明显。决策曲线分析表明,与对所有人进行干预或不进行干预相比,PsyMetRiC 在改善早期精神病患者的心脏代谢风险管理方面可能具有临床实用性:结论:PsyMetRiC可用于预测芬兰早期精神病患者的心脏代谢风险。结论:PsyMetRiC可用于预测芬兰早期精神病患者的心脏代谢风险,与其他现有策略相比,它具有更好的鉴别准确性,并能提供更准确的风险预测。
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引用次数: 0
Digital phenotypes of real-time suicidal ideation: Correlates and consequences. 实时自杀意念的数字表型:相关因素和后果。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-26 DOI: 10.1111/acps.13750
L M M Kivelä, A J W van der Does, R Gilissen, Niki Antypa

Introduction: Suicidal ideation variability refers to within-day fluctuations in suicidal ideation, and has recently been proposed as an indicator of suicide risk. However, not much is known yet about its correlates and clinical relevance.

Methods: We examined characteristics of real-time suicidal ideation using Ecological Momentary Assessment in 82 individuals with current active suicidal ideation. Data were collected four times daily over 21 days. Latent profile analysis was used to identify subtypes of suicidal ideation. We further examined sociodemographic and clinical correlates of the profiles, and their association with the occurrence of suicide attempts during a 1-year follow-up.

Results: We identified three "digital" phenotypes of suicidal ideation that differed on the frequency, intensity and variability of ideation. The profiles were: high frequency, high intensity, moderate variability (Phenotype 1), moderate/high frequency, moderate intensity, high variability (Phenotype 2), and moderate frequency, low intensity, low variability (Phenotype 3). Phenotypes 1 and 2 were associated with a worse clinical profile at baseline (higher suicidal ideation and depressive symptom severity), and increased odds of suicide attempt during follow-up, compared to Phenotype 3. Phenotype 1 was further characterized by repeated suicidal behavior.

Conclusions: Two phenotypes of real-time suicidal ideation were identified that appear to confer a higher risk of suicidal behavior in the near future (12 months). These phenotypes were characterized by higher variability of suicidal ideation-and also higher intensity and frequency of ideation. Considering the small sample size, the clinical usefulness of the profiles remains to be demonstrated.

简介自杀意念变异性是指自杀意念在一天之内的波动,最近被提出作为自杀风险的一个指标。然而,人们对其相关性和临床意义还知之甚少:方法:我们使用生态学瞬间评估对 82 名当前有主动自杀意念的人的实时自杀意念特征进行了研究。数据收集为期 21 天,每天四次。我们使用潜伏特征分析来确定自杀意念的亚型。我们进一步研究了这些特征的社会人口学和临床相关性,以及它们与一年随访期间自杀未遂发生率的关联:结果:我们发现了自杀意念的三种 "数字 "表型,它们在自杀意念的频率、强度和可变性方面各不相同。它们分别是:高频率、高强度、中等变异性(表型 1),中等/高频率、中等强度、高变异性(表型 2),以及中等频率、低强度、低变异性(表型 3)。与表型 3 相比,表型 1 和表型 2 的基线临床特征更差(自杀意念和抑郁症状严重程度更高),随访期间自杀未遂的几率更高。表型 1 的另一个特点是反复出现自杀行为:结论:研究发现了两种实时自杀意念表型,它们似乎会在不久的将来(12 个月)带来更高的自杀行为风险。这些表型的特点是自杀意念的变异性更高,意念的强度和频率也更高。考虑到样本量较小,这些特征的临床实用性还有待证实。
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引用次数: 0
Age-stratified risk of suicide in patients with schizophrenia 精神分裂症患者自杀的年龄分层风险。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-14 DOI: 10.1111/acps.13747
Yueh-Pin Lin, Wen-Yin Chen, Chun-Hung Pan, Sheng-Shiang Su, Shang-Ying Tsai, Chiao-Chicy Chen, Chian-Jue Kuo

Objectives

Schizophrenia is associated with an increased risk of suicide. Few studies have investigated the risk of suicide across different ages, likely due to limitations around sample size.

Methods

From the National Health Insurance Research Database in Taiwan, this study identified 195,787 patients with schizophrenia from January 1, 2000, to December 31, 2019. During the study period, 3848 patients died from suicide. We calculated the standardized mortality ratio (SMR) for suicide stratified by age. In this age-stratified, nested case–control study, risk set sampling was used to match each case with 4 living controls by age, sex, and the year of the first diagnosis with schizophrenia. Conditional logistic regression was used for estimating age-stratified risk profiles.

Results

The SMR was the highest in the <25 years age group (52.8) and inversely correlated with age. Unemployment was associated with an increased risk of suicide in the 25 to 34, 35 to 44, 45 to 54, and 55 to 64 years age groups. Depressive and sleep disorders before suicide were more common among suicide cases with schizophrenia than among controls across all age groups. Drug-induced and alcohol-induced mental disorders were significantly associated with suicide but were observed only in the age group younger than 54. Heart disease, pneumonia, and moderate or severe renal disease were risk factors for suicide in the age groups less than 65.

Conclusions

The risk factors for suicide differ by age. This study's findings can be used to optimize health-care interventions for preventing suicide in patients with schizophrenia.

目的:精神分裂症与自杀风险增加有关。可能由于样本量的限制,很少有研究调查不同年龄段的自杀风险:本研究从台湾的 "国民健康保险研究数据库 "中筛选出 195,787 名精神分裂症患者,时间跨度为 2000 年 1 月 1 日至 2019 年 12 月 31 日。在研究期间,有 3848 名患者死于自杀。我们计算了按年龄分层的自杀标准化死亡率(SMR)。在这项按年龄分层的嵌套病例对照研究中,我们采用了风险集抽样法,按照年龄、性别和首次确诊精神分裂症的年份,将每个病例与 4 个在世的对照组进行匹配。条件逻辑回归用于估算年龄分层风险概况:结论:SMR 在《结论》中最高:自杀的风险因素因年龄而异。这项研究的结果可用于优化医疗干预措施,预防精神分裂症患者自杀。
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引用次数: 0
Progress in perinatal mental health research 围产期心理健康研究的进展。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-13 DOI: 10.1111/acps.13746
Kristina M. Deligiannidis, Jennifer L. Payne
<p>Perinatal psychiatric and substance use disorders are common, yet suboptimal treatment is frequent.<span><sup>1</sup></span> Underdiagnosis and undertreatment of perinatal psychiatric and substance use disorders is associated with poor maternal functioning, increased risk for adverse obstetrical and neonatal outcomes, and abnormal child socioemotional regulation including effects on cognitive and executive function and stress responsivity.<span><sup>2, 3</sup></span> This special issue highlights the importance of the growing subspecialty of perinatal psychiatry with its rich cross-disciplinary approach bridging diverse specialties including obstetrics, neonatology, developmental pediatrics, child and adult psychiatry, psychology, psychiatric epidemiology, neuroscience, and more.</p><p>In this issue, several studies focus on risks associated with the development of perinatal psychiatric disorders or their relationship with a variety of maternal and infant outcomes. Johannsen et al. reported that the baseline risk of developing a mild to severe postpartum psychiatric episode was 6.9%, while for young mothers with a personal and family history of psychiatric disorders, the absolute risk rose to 21.6%, and rose further to 29.2% when information on high genetic liability to depression was added.<span><sup>4</sup></span> While this risk calculation may not include all potential risk factors for an individual patient, these well-established personal risk factors when combined make it possible to identify a vulnerable group of women at significant risk for a postpartum psychiatric episode. Related, Schoretsanitis et al. reported that postpartum hemorrhage, which affects up to one-tenth of women giving birth, is a risk factor for the development of postpartum depression, a risk which was further increased in women with a history of depression or anxiety.<span><sup>5</sup></span></p><p>Huizink et al. examined the normative courses of pregnancy-related anxiety in a large birth cohort.<span><sup>6</sup></span> They identified two distinct trajectories of pregnancy-related anxiety, a low-symptom group (88.6%) with lower and slightly increasing levels of pregnancy-related anxiety, and a moderately high symptoms group (11.4%) who reported higher and slightly decreasing levels of anxiety. The presence of moderately high symptoms was correlated with several general risk factors for mental health disorders including a lower income, use of alcohol or smoking early in pregnancy, more early life adversities, younger age, primiparity, and single parenthood, among others. The authors suggest that women with high levels of pregnancy anxiety throughout pregnancy may need more clinical attention, as their symptoms may point to the presence of other mental health disorder risk factors, which together may negatively affect fetal and infant development and behavior.</p><p>A second group of studies focus on perinatal psychiatric disorder treatments. Research into the trea
14 这种独特的方法使婴儿的抑郁症状和焦虑症状都有了统计学意义上的显著减少,并改善了婴儿的负性情绪。Rommel 等人15 主导的研究探讨了母亲的重度抑郁症遗传责任是否可以解释孕期使用抗抑郁药与较低胎龄和出生体重之间的部分关联。他们证实,孕期服用抗抑郁药与胎龄和出生体重的小幅降低有关。然而,他们发现抑郁症的遗传责任与风险并非线性相关,因此可能仍然存在残余混杂因素,潜在的混杂因素包括怀孕期间的抑郁症状。鉴于妊娠可能是意外的,而且大多数妊娠可能在器官形成过程中才会被发现,因此处方医生应该对所有有可能怀孕的患者进行孕前咨询。在这些共同决策对话中,除了潜在的治疗益处外,还应讨论和记录未经治疗的精神疾病对母婴二人的风险,以及治疗的已知风险(和目前未知的潜在风险)。异丙孕酮在围产期抑郁症的病理生理学方面一直受到积极研究16-18 ,异丙孕酮及其类似物唑拉诺酮已在美国开发用于治疗产后抑郁症19-21。Hare 等人22 报告了围产期抑郁症严重程度与异丙孕酮浓度之间的单向时间关联,以及抑郁症严重程度和异丙孕酮浓度与与情绪调节和认知控制有关的脑区产后结构变化之间的特定关联。这项研究强调了围产期抑郁严重程度、异孕烷醇酮浓度和产后灰质体积之间错综复杂的相互作用,为了解围产期抑郁的神经机制及其对针对性干预的潜在影响提供了宝贵的见解。另一项研究探讨了围产期抑郁与脑源性神经营养因子(BDNF)之间的关系,BDNF 参与神经元生长、神经元分化和突触可塑性,可在外周血中测定,被认为可反映脑组织中的 BDNF 水平。荟萃分析表明,产前抑郁症患者和产后抑郁症患者的脑源性神经营养因子水平均显著下降。首先,了解在这一关键时期的最佳治疗策略,从而优化父母和儿童的治疗效果,对于减少悲剧的发生和将围产期精神疾病的影响降至最低至关重要。其次,确定风险因素和生物标志物,尤其是确定围产期精神疾病高危人群的风险因素和生物标志物,最终将有助于临床治疗的预防性而非被动性。最后,围产期精神疾病的发病时间是可以预测的,因此可以在发病前后对各种生物过程进行测量,从而对潜在的病理生理学进行研究。找出产后抑郁症等疾病的生物学过程,很可能会加深对重度抑郁症的理解,进而改善治疗方法和总体疗效。本特刊表明,围产期心理健康研究正在取得进展。我们期待看到这些重要发现的临床影响。KMD还担任Sage Therapeutics、Biogen、Brii Biosciences、Gerbera Therapeutics、Neuroscience Software和Reunion Neuroscience的顾问。KMD 曾担任由 Sage Therapeutics、Nesos Corporation、Gerbera Therapeutics、Woebot Health 和 Premier Healthcare 授予费恩斯坦医学研究所(Feinstein Institutes for Medical Research)的合同研究的主要研究员。JLP获得了美国国立卫生研究院、杨森制药公司(Janssen Pharmaceuticals)和Myriad Genetics公司的研究支持。佩恩博士拥有两项专利:"产后抑郁症的表观遗传生物标志物 "和 "经前多愁善感症和 SSRI 反应的表观遗传生物标志物"。佩恩博士拥有 Dionysus Health 创始人股票期权。佩恩博士
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引用次数: 0
Diagnostic value of structural, functional and effective connectivity in bipolar disorder. 双相情感障碍的结构连接、功能连接和有效连接的诊断价值。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-13 DOI: 10.1111/acps.13742
Teodora M Gencheva, Bozhidar V Valkov, Sevdalina S Kandilarova, Michael H J Maes, Drozdstoy S Stoyanov

Introduction: The aim of this systematic review is to assess the functional magnetic resonance imaging (fMRI) studies of bipolar disorder (BD) patients that characterize differences in terms of structural, functional, and effective connectivity between the patients with BD, patients with other psychiatric disorders and healthy controls as possible biomarkers for diagnosing the disorder using neuroimaging.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), guidelines a systematic search for recent (since 2015) original studies on connectivity in bipolar disorder was conducted in PUBMED and SCOPUS.

Results: A total of 60 studies were included in this systematic review: 20 of the structural connectivity, 33 of the functional connectivity, and only 7 of the studies focused on effective connectivity complied with the inclusion and exclusion criteria.

Discussion: Despite the great heterogeneity in the findings, there are several trends that emerge. In structural connectivity studies, the main abnormalities in bipolar disorder patients were in the frontal gyrus, anterior, as well as posterior cingulate cortex and differences in emotion and reward-related networks. Cerebellum (vermis) to cerebrum functional connectivity was found to be the most common finding in BD. Moreover, prefrontal cortex and amygdala connectivity as part of the rich-club hubs were often reported to be disrupted. The most common findings based on effective connectivity were alterations in salience network, default mode network and executive control network. Although more studies with larger sample sizes are needed to ascertain altered brain connectivity as diagnostic biomarker, there is a perspective that the method could be used as a single marker of diagnosis in the future, and the process of adoption could be accelerated by using approaches such as semiunsupervised machine learning.

导言:本系统性综述旨在评估双相情感障碍(BD)患者的功能磁共振成像(fMRI)研究,这些研究描述了双相情感障碍患者、其他精神疾病患者和健康对照组之间在结构、功能和有效连接性方面的差异,并将其作为利用神经影像学诊断双相情感障碍的可能生物标志物:根据《系统综述和荟萃分析首选报告项目》(PRISMA)指南,在 PUBMED 和 SCOPUS 上对近期(2015 年以来)有关双相情感障碍连通性的原创研究进行了系统检索:本系统性综述共纳入了 60 项研究:20项结构连通性研究、33项功能连通性研究,只有7项关注有效连通性的研究符合纳入和排除标准:讨论:尽管研究结果存在很大的异质性,但还是出现了一些趋势。在结构连接研究中,双相情感障碍患者的主要异常部位是额回、前扣带回和后扣带回皮层,情绪和奖赏相关网络也存在差异。小脑(蚓部)到大脑的功能连接是双相情感障碍最常见的发现。此外,前额叶皮层和杏仁核作为富俱乐部枢纽的一部分,其连接也经常被报告为中断。基于有效连接的最常见发现是显著性网络、默认模式网络和执行控制网络的改变。虽然需要更多样本量更大的研究来确定大脑连通性的改变作为诊断生物标志物,但有一种观点认为,这种方法在未来可用作诊断的单一标志物,而采用半无监督机器学习等方法可加快采用的进程。
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引用次数: 0
Using computer vision of facial expressions to assess symptom domains and treatment response in antipsychotic-naïve patients with first-episode psychosis. 使用面部表情计算机视觉评估抗精神病药物无效的首发精神病患者的症状领域和治疗反应。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-12 DOI: 10.1111/acps.13743
Karen S Ambrosen, Cecilie K Lemvigh, Mette Ø Nielsen, Birte Y Glenthøj, Warda T Syeda, Bjørn H Ebdrup

Background: Facial expressions are a core aspect of non-verbal communication. Reduced emotional expressiveness of the face is a common negative symptom of schizophrenia, however, quantifying negative symptoms can be clinically challenging and involves a considerable element of rater subjectivity. We used computer vision to investigate if (i) automated assessment of facial expressions captures negative as well as positive and general symptom domains, and (ii) if automated assessments are associated with treatment response in initially antipsychotic-naïve patients with first-episode psychosis.

Method: We included 46 patients (mean age 25.4 (6.1); 65.2% males). Psychopathology was assessed at baseline and after 6 weeks of monotherapy with amisulpride using the Positive and Negative Syndrome Scale (PANSS). Baseline interview videos were recorded. Seventeen facial action units (AUs), that is, activation of muscles, from the Facial Action Coding System were extracted using OpenFace 2.0. A correlation matrix was calculated for each patient. Facial expressions were identified using spectral clustering at group-level. Associations between facial expressions and psychopathology were investigated using multiple linear regression.

Results: Three clusters of facial expressions were identified related to different locations of the face. Cluster 1 was associated with positive and general symptoms at baseline, Cluster 2 was associated with all symptom domains, showing the strongest association with the negative domain, and Cluster 3 was only associated with general symptoms. Cluster 1 was significantly associated with the clinically rated improvement in positive and general symptoms after treatment, and Cluster 2 was significantly associated with clinical improvement in all domains.

Conclusion: Using automated computer vision of facial expressions during PANSS interviews did not only capture negative symptoms but also combinations of the three overall domains of psychopathology. Moreover, automated assessments of facial expressions at baseline were associated with initial antipsychotic treatment response. The findings underscore the clinical relevance of facial expressions and motivate further investigations of computer vision in clinical psychiatry.

背景介绍面部表情是非语言交流的一个核心方面。面部情绪表达能力减弱是精神分裂症的常见阴性症状,然而,阴性症状的量化在临床上具有挑战性,而且涉及相当大的评分者主观因素。我们利用计算机视觉来研究:(i) 面部表情的自动评估是否能捕捉阴性以及阳性和一般症状领域;(ii) 自动评估是否与最初未使用抗精神病药的首发精神病患者的治疗反应有关:我们纳入了 46 名患者(平均年龄 25.4 (6.1);65.2% 为男性)。在使用氨磺必利单药治疗基线期和6周后,使用阳性和阴性综合征量表(PANSS)对患者的精神病理学进行评估。基线访谈视频均已录制。使用 OpenFace 2.0 从面部动作编码系统中提取了 17 个面部动作单元(AU),即肌肉的激活。为每位患者计算相关矩阵。使用频谱聚类在组水平上识别面部表情。使用多元线性回归法研究了面部表情与精神病理学之间的关联:结果:确定了与面部不同位置相关的三个面部表情群。第 1 组与基线时的积极症状和一般症状相关,第 2 组与所有症状领域相关,其中与消极领域的相关性最强,而第 3 组仅与一般症状相关。第 1 组与治疗后临床评定的积极症状和一般症状的改善明显相关,第 2 组与所有领域的临床改善明显相关:结论:在 PANSS 访谈中使用计算机自动视觉识别面部表情不仅能捕捉到阴性症状,还能捕捉到精神病理学三个总体领域的组合。此外,基线时的面部表情自动评估与最初的抗精神病治疗反应相关。这些发现强调了面部表情的临床相关性,并推动了计算机视觉在临床精神病学中的进一步研究。
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引用次数: 0
The relationship between childhood adversity and affective instability across psychiatric disorders: A meta-analysis. 童年逆境与各种精神障碍的情感不稳定性之间的关系:荟萃分析
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-11 DOI: 10.1111/acps.13745
Jasper Palmier-Claus, Rebecca Golby, Laura-Jean Stokes, Christopher W N Saville, Kyriakos Velemis, Filippo Varese, Steven Marwaha, Elizabeth Tyler, Peter Taylor

Introduction: Affective instability represents an important, transdiagnostic biobehavioural dimension of mental ill health and clinical outcome. The causes of affective instability remain unclear. This systematic review and meta-analysis evaluated the extent to which exposure to childhood adversity is associated with affective instability across psychiatric disorders, and which forms of adversity are most strongly associated with affective instability.

Methods: The review followed a published protocol (PROSPERO: CRD42020168676). Searches in Medline, Embase and PsychInfo identified studies using quantitative measures of childhood adversity and affective instability, published between January 1980 and July 2023. Data were analysed using a random effects meta-analysis separately for each outcome, namely affective lability, emotion dysregulation, and rapid cycling. The Mixed-Methods Appraisal Tool was used to appraise the quality of the literature.

Results: The search identified 36 studies involving 8431 participants. All reports focused on cross-sectional associations. We did not identify any prospective longitudinal research. The analysis showed small, but statistically significant effects of childhood adversity on affective lability (r = 0.09, 95% CI 0.02, 0.17), emotion dysregulation (r = 0.25, 95% CI 0.19, 0.32), and rapid cycling (OR = 1.39; 95% CI 1.14, 1.70). When considering adversity subtypes, emotional abuse showed the strongest effect on affective lability (r = 0.16, 95% CI 0.07, 0.24) and emotion dysregulation (r = 0.32, 95% CI 0.19, 0.44). Quality assessment scores were generally low. Most studies failed to control for confounding factors or offer assurances around the representativeness of the samples.

Conclusions: The findings suggest that childhood adversity, particularly emotional abuse, is associated emotional instability in adulthood, but further prospective longitudinal research is needed to confirm causality. The findings have implications for the prevention and treatment of affective instability across psychiatric disorders.

简介情绪不稳定是精神疾病和临床结果的一个重要的跨诊断生物行为维度。情绪不稳定的原因尚不清楚。本系统综述和荟萃分析评估了童年逆境与各种精神疾病的情感不稳定性的相关程度,以及哪种形式的逆境与情感不稳定性的关系最为密切:综述遵循已发布的协议(PROSPERO:CRD42020168676)。在Medline、Embase和PsychInfo中进行检索,确定了1980年1月至2023年7月期间发表的使用定量测量童年逆境和情感不稳定性的研究。采用随机效应荟萃分析法分别对每种结果(即情感不稳定性、情绪失调和快速循环)进行数据分析。采用混合方法评估工具对文献质量进行评估:搜索发现了 36 项研究,涉及 8431 名参与者。所有报告都侧重于横断面关联。我们没有发现任何前瞻性纵向研究。分析表明,童年逆境对情绪易变性(r = 0.09,95% CI 0.02,0.17)、情绪失调(r = 0.25,95% CI 0.19,0.32)和快速循环(OR = 1.39;95% CI 1.14,1.70)的影响较小,但具有统计学意义。在考虑逆境亚型时,情感虐待对情绪易变(r = 0.16,95% CI 0.07,0.24)和情绪失调(r = 0.32,95% CI 0.19,0.44)的影响最大。质量评估得分普遍较低。大多数研究未能控制混杂因素或保证样本的代表性:研究结果表明,童年时期的逆境,尤其是情感虐待,与成年后的情绪不稳定性有关,但需要进一步的前瞻性纵向研究来确认因果关系。这些研究结果对预防和治疗各种精神疾病的情绪不稳定性具有重要意义。
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引用次数: 0
The relationship between blinding integrity and medication efficacy in randomised-controlled trials in patients with anxiety disorders: A systematic review and meta-analysis 焦虑症患者随机对照试验中盲法完整性与药物疗效之间的关系:系统回顾与荟萃分析。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-10 DOI: 10.1111/acps.13741
Ruqayyah Haq, Laura Molteni, Nathan T. M. Huneke
<div> <section> <h3> Background</h3> <p>Blinding is thought to minimise expectancy effects and biases in double-blind randomised-controlled trials (RCTs). However, whether blinding integrity should be assessed and reported remains debated. Furthermore, it is unknown whether blinding failure influences the outcome of RCTs in anxiety disorders. We carried out a systematic review to understand whether blinding integrity is assessed and reported in anxiolytic RCTs. A secondary aim was to explore whether blinding integrity is associated with treatment efficacy.</p> </section> <section> <h3> Method</h3> <p>Our protocol was pre-registered (PROSPERO CRD42022328750). We searched electronic databases for placebo-controlled, randomised trials of medication in adults with generalised and social anxiety disorders, and in panic disorder, from 1980. We extracted data regarding blinding integrity and treatment efficacy. Risk of bias was assessed with the Cochrane risk of bias tool. Where possible, we subsequently calculated Bang's Blinding Index, and assessed the association between blinding integrity and treatment effect size.</p> </section> <section> <h3> Results</h3> <p>Of the 247 RCTs that met inclusion criteria, we were able to obtain assessments of blinding integrity from nine (3.64%). Overall, blinding failed in five of these trials (55.56%), but blinding was intact in 80% of placebo arms. We found a significant association between reduced blinding integrity among assessors and increased treatment effect size (betas < −1.30, <i>p</i>'s < 0.001), but this analysis involved only four studies of which two were outlying studies. In patients, we saw a non-significant trend where reduced blinding integrity in the placebo groups was associated with <i>increased</i> treatment efficacy, which was not present in active medication arms. [Correction added on 19 August 2024, after first online publication: Results of the RCTs and its assessment of blinding integrity have been updated.]</p> </section> <section> <h3> Conclusion</h3> <p>Consistent with work in other psychiatric disorders, blinding integrity is rarely reported in anxiolytic RCTs. Where it is reported, blinding appears to often fail. We found signals that suggest unblinding of clinician assessors (driven by two studies with complete unblinding), and of patients in placebo arms, might be associated with larger treatment effect sizes. We recommend that data regarding blinding integrity, along with the reasons patients and assessors offer for their beliefs regarding group allocation, are systematically co
背景:在双盲随机对照试验(RCT)中,盲法被认为可以最大限度地减少预期效应和偏差。然而,是否应评估和报告盲法的完整性仍存在争议。此外,盲法失败是否会影响焦虑症 RCT 的结果,目前尚不得而知。我们开展了一项系统性综述,以了解抗焦虑药 RCT 是否对盲法的完整性进行了评估和报告。次要目的是探讨盲法的完整性是否与治疗效果相关:我们的研究方案已预先注册(PROSPERO CRD42022328750)。我们在电子数据库中搜索了自 1980 年以来针对成人广泛性焦虑症、社交焦虑症和惊恐障碍的安慰剂对照随机药物试验。我们提取了有关盲法完整性和治疗效果的数据。偏倚风险采用 Cochrane 偏倚风险工具进行评估。在可能的情况下,我们随后计算了Bang的盲法指数,并评估了盲法完整性与治疗效果大小之间的关联:在符合纳入标准的 248 项研究中,我们获得了 9 项(3.63%)研究的盲法完整性评估。总体而言,其中五项试验(55.56%)的盲法失效,但80%的安慰剂治疗臂的盲法是完整的。我们发现,评估者盲法完整性的降低与治疗效果大小的增加之间存在明显关联(贝塔系数<-6.50,P's 结论:与其他精神疾病的研究结果一致,盲法完整性的降低与治疗效果大小的增加之间存在明显关联:与其他精神疾病的研究结果一致,抗焦虑药物临床试验中很少有关于盲法完整性的报道。在有报道的研究中,盲法似乎经常失效。我们发现有迹象表明,解除对临床医生评估者的盲法(由两项完全解除盲法的研究驱动)以及解除对安慰剂治疗组患者的盲法,可能与更大的治疗效果相关。我们建议在抗焦虑治疗的研究中系统地收集有关盲法完整性的数据,以及患者和评估者就其对组别分配的看法所提出的理由。
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引用次数: 0
Acoustic features from speech as markers of depressive and manic symptoms in bipolar disorder: A prospective study. 作为双相情感障碍抑郁症和躁狂症状标记的语音声学特征:前瞻性研究。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-08 DOI: 10.1111/acps.13735
Katarzyna Kaczmarek-Majer, Monika Dominiak, Anna Z Antosik, Olgierd Hryniewicz, Olga Kamińska, Karol Opara, Jan Owsiński, Weronika Radziszewska, Małgorzata Sochacka, Łukasz Święcicki

Introduction: Voice features could be a sensitive marker of affective state in bipolar disorder (BD). Smartphone apps offer an excellent opportunity to collect voice data in the natural setting and become a useful tool in phase prediction in BD.

Aims of the study: We investigate the relations between the symptoms of BD, evaluated by psychiatrists, and patients' voice characteristics. A smartphone app extracted acoustic parameters from the daily phone calls of n = 51 patients. We show how the prosodic, spectral, and voice quality features correlate with clinically assessed affective states and explore their usefulness in predicting the BD phase.

Methods: A smartphone app (BDmon) was developed to collect the voice signal and extract its physical features. BD patients used the application on average for 208 days. Psychiatrists assessed the severity of BD symptoms using the Hamilton depression rating scale -17 and the Young Mania rating scale. We analyze the relations between acoustic features of speech and patients' mental states using linear generalized mixed-effect models.

Results: The prosodic, spectral, and voice quality parameters, are valid markers in assessing the severity of manic and depressive symptoms. The accuracy of the predictive generalized mixed-effect model is 70.9%-71.4%. Significant differences in the effect sizes and directions are observed between female and male subgroups. The greater the severity of mania in males, the louder (β = 1.6) and higher the tone of voice (β = 0.71), more clearly (β = 1.35), and more sharply they speak (β = 0.95), and their conversations are longer (β = 1.64). For females, the observations are either exactly the opposite-the greater the severity of mania, the quieter (β = -0.27) and lower the tone of voice (β = -0.21) and less clearly (β = -0.25) they speak - or no correlations are found (length of speech). On the other hand, the greater the severity of bipolar depression in males, the quieter (β = -1.07) and less clearly they speak (β = -1.00). In females, no distinct correlations between the severity of depressive symptoms and the change in voice parameters are found.

Conclusions: Speech analysis provides physiological markers of affective symptoms in BD and acoustic features extracted from speech are effective in predicting BD phases. This could personalize monitoring and care for BD patients, helping to decide whether a specialist should be consulted.

简介语音特征可能是双相情感障碍(BD)患者情感状态的敏感标记。智能手机应用程序提供了在自然环境中收集语音数据的绝佳机会,并成为预测躁狂症阶段的有用工具:我们研究了由精神科医生评估的 BD 症状与患者声音特征之间的关系。智能手机应用程序从 51 名患者的日常通话中提取了声音参数。我们展示了拟声、频谱和语音质量特征与临床评估的情感状态之间的相关性,并探讨了它们在预测 BD 阶段中的作用:开发了一款智能手机应用程序(BDmon),用于收集语音信号并提取其物理特征。BD患者平均使用该应用程序208天。精神科医生使用汉密尔顿抑郁评分量表-17 和青年躁狂评分量表评估 BD 症状的严重程度。我们使用线性广义混合效应模型分析了语音声学特征与患者精神状态之间的关系:结果:拟声、频谱和语音质量参数是评估躁狂和抑郁症状严重程度的有效标记。预测性广义混合效应模型的准确率为 70.9%-71.4%。女性和男性亚组之间的效应大小和方向存在显著差异。男性躁狂症的严重程度越高,他们说话的声音越大(β = 1.6)、语调越高(β = 0.71)、越清晰(β = 1.35)、越尖锐(β = 0.95),谈话的时间越长(β = 1.64)。对于女性,观察结果要么正好相反--躁狂症越严重,她们说话的声音越小(β = -0.27),语调越低(β = -0.21),说话越不清楚(β = -0.25)--要么没有相关性(说话时间长)。另一方面,男性双相抑郁的严重程度越高,他们说话的声音越小(β = -1.07 ),说话的清晰度越低(β = -1.00 )。在女性中,抑郁症状的严重程度与语音参数的变化之间没有明显的相关性:结论:语音分析提供了 BD 情感症状的生理标记,从语音中提取的声学特征可有效预测 BD 阶段。这可以对 BD 患者进行个性化监测和护理,帮助决定是否应咨询专科医生。
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引用次数: 0
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Acta Psychiatrica Scandinavica
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