Acta Psychiatrica Scandinavica最新文献_第3页

Generative Artificial Intelligence (AI) and the Outsourcing of Scientific Reasoning: Perils of the Rising Cognitive Debt in Academia and Beyond. 生成式人工智能（AI）和科学推理的外包：学术界及其他领域不断上升的认知债务的危险。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2026-01-21 DOI: 10.1111/acps.70069

Søren Dinesen Østergaard

引用次数: 0

Mortality Gap for People With Schizophrenia Spectrum Disorders: An Elephant in the Room? 精神分裂症谱系障碍患者的死亡率差距：房间里的大象？

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2026-01-19 DOI: 10.1111/acps.70070

Alain Braillon

引用次数: 0

Impact of Schizophrenia Spectrum Disorders on the Receipt of Invasive and Systemic Therapy for Colorectal Cancer: A Nationwide Multicenter Retrospective Cohort Study in Japan 精神分裂症谱系障碍对结直肠癌侵入性和全身治疗的影响：日本一项全国性多中心回顾性队列研究

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2026-01-14 DOI: 10.1111/acps.70065

Masaki Fujiwara, Yuto Yamada, Taisuke Ishii, Tomone Watanabe, Maiko Fujimori, Naoki Nakaya, Toshihiko Kawamura, Koji Otsuki, Kunitoshi Shigeyasu, Taichi Shimazu, Shiro Hinotsu, Yosuke Uchitomi, Masatoshi Inagaki

Introduction

This study examined treatment disparities for colorectal cancer among patients diagnosed with schizophrenia spectrum disorders (SSD), focusing on invasive treatments and stage-appropriate systemic therapy within a universal healthcare system.

Method

In this nationwide retrospective cohort study (2018–2021), we identified 248,966 colorectal cancer patients, including 2337 diagnosed with SSD, using linked cancer registry and insurance claims data in Japan. The presence of SSD was classified according to ICD-10 codes F20–29. We used multivariable logistic regression to compare the odds of receiving stage-appropriate adjuvant chemotherapy and systemic therapy, as well as the odds of receiving surgical or endoscopic treatments, between the two groups. The analysis adjusted for age, sex, clinical stage, and scores on the Charlson Comorbidity Index and Barthel Index.

Results

The clinical stage distribution at diagnosis for colorectal cancer differed significantly between patients with SSD and those without psychiatric disorders (p < 0.001). After adjusting for clinical stage and other covariates, patients with SSD demonstrated significantly lower odds of receiving surgical or endoscopic treatment (adjusted odds ratio [aOR], 0.83; 95% CI, 0.73–0.94). The disparities were more pronounced for systemic therapy; patients with SSD had substantially lower odds of receiving adjuvant chemotherapy for stage III disease (aOR, 0.33; 95% CI, 0.26–0.41) and systemic therapy for stage IV disease (aOR, 0.23; 95% CI, 0.17–0.31).

Conclusion

Patients with SSD encounter substantial disparities in accessing standard colorectal cancer care, particularly systemic therapies. These findings highlight the urgent need for interventions to ensure equitable cancer treatment for this vulnerable population.

导读：本研究调查了被诊断为精神分裂症谱系障碍（SSD）的结直肠癌患者的治疗差异，重点研究了在全民医疗保健系统中侵入性治疗和适合分期的全身治疗。方法：在这项全国性的回顾性队列研究（2018-2021）中，我们使用日本相关的癌症登记和保险索赔数据，确定了248,966名结直肠癌患者，其中2337名被诊断为SSD。SSD的存在根据ICD-10代码F20-29进行分类。我们使用多变量逻辑回归来比较两组患者接受适合分期的辅助化疗和全身治疗的几率，以及接受手术或内窥镜治疗的几率。分析调整了年龄、性别、临床分期、查尔森合并症指数和巴特尔指数得分。结果：SSD患者与无精神障碍患者在结直肠癌诊断时的临床分期分布有显著差异(p结论：SSD患者在获得标准结直肠癌治疗，特别是全身治疗方面存在实质性差异。这些发现突出了干预措施的迫切需要，以确保这一弱势群体获得公平的癌症治疗。

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引用次数: 0

Evidence of a Widening Mortality Gap for People With Schizophrenia Spectrum Disorders: Implications for Early Intervention Services 精神分裂症谱系障碍患者死亡率差距扩大的证据：早期干预服务的意义。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-19 DOI: 10.1111/acps.70061

Alexis E. Cullen

<p>In their recent article, Plana-Ripoll and colleagues investigate temporal trends in mortality rates among individuals treated for mental disorders over a 14-year period in Denmark [<span>1</span>]. This well-conducted study, which included nationwide data from over 7 million individuals, compared standardised mortality rates (SMRs) for individuals with mental disorders and members of the general population across five time-periods, including the COVID-19 pandemic (2010–2012 vs. 2013–2015 vs. 2016–2018 vs. 2019–2021 vs. 2022–2023). The authors reported that whilst SMRs reduced over time for most mental disorders (including depression, anxiety and personality disorders) or remained stable (bipolar disorder), those for schizophrenia spectrum disorders (SSDs), organic disorders and (to a lesser extent) substance use disorders increased. The worsening outcomes observed for people with SSDs are in line with findings from a recent study examining temporal trends in life expectancy among individuals with severe mental illness in Scotland [<span>2</span>]: In that study, the life expectancy gap relative to the general population was unchanged for individuals with major depression and bipolar disorder between 2000 and 2019, yet the gap increased over the study period for those with schizophrenia. In contrast, a study conducted in Hong Kong observed that SMRs for people with schizophrenia showed minimal change over time, whilst those for other SSDs were slightly lower in 2012–2016 compared to 2006–2011 [<span>3</span>].</p><p>Together, these investigations provide evidence of a persistent mortality gap among individuals with SSDs, which in the case of Denmark and Scotland, has widened over time. The trends observed in Denmark are particularly concerning given the significant investment in early intervention (EI) services (via the OPUS programme) over the past three decades [<span>4</span>]. Indeed, Denmark was among the first countries to adopt the EI model, which has been implemented nationally since 2003 [<span>5</span>]. This editorial discusses the implications of these findings for EI services and provides suggestions for future research to enable us to understand and address the persistent mortality gap for people with SSDs.</p><p>By definition, SMRs are relative and therefore directly influenced by mortality rates in the general population as well as rates in the subpopulation of interest. The observed increase in SMRs for individuals with SSDs may therefore be due to a reduction in mortality rates in the general population which has not occurred (or at least not to the same extent) among individuals with SSDs, or an actual increase in mortality rates among individuals with SSDs. Thus, it is essential to consider both absolute and relative measures of mortality. A strength of the paper by Plana-Ripoll is that both outcome measures are presented: Here, we see that the crude (age-standardised) mortality rate per 1000 person-years among individuals w

在他们最近的一篇文章中，Plana-Ripoll和他的同事调查了在丹麦接受了14年精神障碍治疗的个体死亡率的时间趋势。这项进行良好的研究包括来自700多万人的全国数据，比较了五个时期精神障碍患者和普通人群的标准化死亡率（smr），包括COVID-19大流行（2010-2012年与2013-2015年、2016-2018年、2019-2021年与2022-2023年）。作者报告说，随着时间的推移，大多数精神障碍（包括抑郁、焦虑和人格障碍）的smr会减少或保持稳定（双相情感障碍），而精神分裂症谱系障碍（ssd）、器质性障碍和（在较小程度上）物质使用障碍的smr会增加。ssd患者观察到的恶化结果与最近一项研究的结果一致，该研究调查了苏格兰严重精神疾病患者预期寿命的时间趋势：在该研究中，2000年至2019年期间，重度抑郁症和双相情感障碍患者相对于一般人群的预期寿命差距没有变化，但精神分裂症患者的预期寿命差距在研究期间有所扩大。相比之下，在香港进行的一项研究发现，精神分裂症患者的smr随着时间的推移变化很小，而其他ssd的smr在2012-2016年与2006-2011年相比略有下降。总之，这些调查提供的证据表明，在使用固态硬盘的人群中，死亡率差距持续存在，在丹麦和苏格兰的情况下，这种差距随着时间的推移而扩大。考虑到在过去三十年中（通过OPUS计划）对早期干预（EI）服务的大量投资，在丹麦观察到的趋势尤其令人担忧。事实上，丹麦是最早采用EI模式的国家之一，该模式自2003年以来一直在全国范围内实施。这篇社论讨论了这些发现对EI服务的影响，并为未来的研究提供了建议，使我们能够理解和解决固态硬盘患者持续存在的死亡率差距。根据定义，最低死亡率是相对的，因此直接受到一般人口死亡率以及相关亚人口死亡率的影响。因此，观察到的固态硬盘患者死亡风险增加可能是由于一般人群的死亡率下降，而这种情况在固态硬盘患者中没有发生（或至少没有达到相同程度），或者固态硬盘患者的死亡率实际上升。因此，必须同时考虑死亡率的绝对和相对量度。Plana-Ripoll的这篇论文的优势在于，两种结果指标都得到了展示：在这里，我们看到，ssd患者每1000人年的粗死亡率（年龄标准化）实际上在前12年的每个后续时间段都有所下降（从2010-2012年的21.99下降到2019-2021年的18.83），但在最后2年期间有所上升（在2022-2023年增加到20.49）。重要的是，在自然原因和外部原因造成的死亡中也观察到同样的模式，男女都有。同样，提供给一般人群的粗略死亡率（对所有精神障碍患者进行年龄标准化）显示，死亡率在头12年有所下降，随后在最后2年有所上升，与COVID-19大流行相吻合。这些研究结果表明，在丹麦，ssd患者的健康状况改善程度不同，但COVID-19大流行（以及相关限制）可能对这些疾病患者的健康产生了更负面的影响。包括丹麦在内的几个欧洲国家在2019冠状病毒病大流行之前的30年里预期寿命有所延长，这归因于健康行为（如饮食、身体活动、烟草/酒精消费）和获得医疗保健的改善。显然，迫切需要了解为什么使用固态硬盘的人没有从这些人口健康改善中受益。ssd患者死亡率差距扩大的一个可能解释是，随机对照试验（rct）中看到的EI的有益效果在现实环境中实施时被削弱了（即“疗效差距”）。然而，在最初的OPUS试验中，在1年、2年或5年随访中，随机分配到OPUS组（N = 275）与标准治疗组（N = 272）的个体在自杀企图或自杀念头方面没有显著的组间差异[7,8]。此外，最近的一项随访研究观察到，OPUS组和标准护理组的全因死亡率没有差异，但在丹麦登记册中确定的在现实环境中接受OPUS的个体（N = 3328）与在初始随机对照试验bb0中接受OPUS的个体相比，全因死亡率（仅粗略分析）显著降低。因此，没有证据表明OPUS对全因死亡率的任何有益影响在现实环境中减弱。相比之下，最近一项对照研究的荟萃分析报告称，EI与自杀死亡人数的减少有关[9]：值得注意的是，五项报告自杀死亡人数显著减少的原始研究中，有三项都评估了香港青少年精神病早期评估服务（EASY[10]）。因此，研究以人群为基础的情商计划的哪些具体组成部分可能导致ssd患者自杀风险的降低，是一个高度优先考虑的问题。干预措施能在多大程度上改善这一人群的身体健康尚不清楚。事实上，CHANGE试验（包括428名患有腹部肥胖的ssd患者）观察到，随机接受12个月生活方式指导+护理协调+常规治疗与护理协调+常规治疗相比，接受常规治疗与单独治疗相比，10年心血管疾病风险无显著差异。显然，需要进一步的工作来开发更有效的治疗方法来治疗ssd患者的这些结果，并确保这些干预措施可以在现实环境中可行地实施。如果这些干预措施符合患者的需求和偏好，那么通过公共卫生举措或专门保健来缩小ssd患者死亡率差距的尝试将更有可能成功。因此，调查患者报告的治疗重点和未满足需求的研究可以深入了解可能导致持续死亡率差距的因素。不幸的是，以前对ssd患者的感知护理需求和治疗偏好的大规模调查使用了结构化工具，不包括与自杀或身体健康有关的领域。值得注意的是，其中一项研究要求患者列出他们希望得到心理帮助的其他领域（在问卷中列出的领域之外），结果发现只有约1%的参与者报告了“身体健康”、“体育锻炼”和“体重管理/饮食”，而“自我伤害”和“自杀意念”方面的帮助分别由0.3%和0.2%的受访者报告。同样，在德尔菲研究中，精神病患者根据治疗优先级和偏好的重要性对77个项目进行评分，15个项目中没有一个被≥80%的参与者评为与身体健康或自杀倾向相关的必要或重要项目。这些初步发现表明，改善身体健康和减少自杀行为对固态硬盘患者来说，可能不如他们健康的其他方面那么重要。这可能是因为阳性精神病症状和其他精神障碍（如焦虑、压力、担忧和失眠）比对身体健康和自杀的担忧更严重、更频繁和更令人痛苦。也有可能患有ssd的个体没有充分意识到这些结果的风险大大增加，或者他们被认为太远而不需要立即关注。了解为什么这些结果对ssd患者没有更大的重要性，需要提高针对性干预的成功率。在ssd患者中观察到的持续[3]和不断扩大的[1,2]死亡率差距表明，显然需要新的、基于证据的方法来改善这些患者的预后。如上所述，如果我们只关注精神科服务的作用，这些改变将难以实现。事实上，这种方法必须结合公共卫生观点（确保一般人群死亡率的改善也有利于ssd患者）、临床观点（在EI服务中开发和实施能够有效降低自然和非自然原因导致的死亡风险的治疗方法）和患者观点（了解为什么这些结果可能不被视为需要的领域，以及这如何影响治疗参与和反应）。为实现这一目标，迫切需要在精神病学研究和卫生保健方面进行大量投资。虽然许多国家已经朝着这一目标采取了步骤，但在我们看到真正的变化之前，可能需要更雄心勃勃、资金充足的长期研究项目。展望未来，我们必须将人口健康、临床和患者的观点结合起来，以便更好地理解为什么缩小固态硬盘患者死亡率差距的努力未能奏效，从而改善这一人群的长期结果。起草并编辑原稿。作者没有什么可报道的。作者没有什么可报道的。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究中没有生成或分析数据集。

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引用次数: 0

Diagnostic Conversion From Psychotic Unipolar Depression to Bipolar and Psychotic Disorders: A Swedish Registry-Based Study 从精神病性单极抑郁症到双相情感障碍和精神障碍的诊断转换：瑞典一项基于登记的研究。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-17 DOI: 10.1111/acps.70059

Ahmed Al-Wandi, Mikael Landén, Axel Nordenskjöld

Objective

To estimate the cumulative incidence of diagnostic conversion from psychotic unipolar depression to bipolar and psychotic disorders in Sweden.

Methods

Data from Swedish national registers were used to identify incident cases of psychotic unipolar depression between 2005 and 2011. To minimize the risk of misclassification, patients with a prior history of psychotic disorders, bipolar disorders, or manic episodes were excluded. Patients were followed until the first occurrence of a diagnostic change, death, or December 31, 2021. The cumulative incidence of diagnostic change was estimated using a competing risk model.

Results

A total of 7836 patients diagnosed with psychotic depression between 2005 and 2011 were included. The median age at index diagnosis of psychotic depression was 49 years (interquartile range: 35–65), and 56.7% were women. By the end of follow-up, 28.8% (95% CI: 27.7–29.9) of patients had undergone a diagnostic change to either a psychotic or bipolar disorder. The cumulative incidence of conversion was higher to psychotic disorders (17.5%, 95% CI: 16.6–18.4) than to bipolar disorders (14.7%, 95% CI: 13.8–15.5). In a sensitivity analysis requiring at least two recorded diagnoses separated by ≥ 1 year, the overall incidence of diagnostic change decreased to 19.0% (95% CI: 18.1–20.0), with corresponding rates of 10.0% (95% CI: 9.3–10.7) to psychotic disorders and 9.8% (95% CI: 9.1–10.5) to bipolar disorders. Diagnostic conversion was more common among younger individuals.

Conclusion

Approximately 20%–30% of patients diagnosed with psychotic depression in secondary care in Sweden are expected to receive a subsequent diagnosis of a bipolar or psychotic disorder within 17 years. This has important clinical implications, as prognosis and treatment strategies differ between these conditions. Further research is needed to identify risk factors for diagnostic conversion to improve early detection and management.

目的：估计在瑞典从精神病性单极抑郁症到双相和精神障碍诊断转换的累积发生率。方法：使用瑞典国家登记处的数据来确定2005年至2011年间精神病性单极抑郁症的病例。为了尽量减少错误分类的风险，排除了既往有精神障碍、双相情感障碍或躁狂发作史的患者。对患者进行随访，直到首次出现诊断变化、死亡或2021年12月31日。使用竞争风险模型估计诊断改变的累积发生率。结果：2005 - 2011年共纳入诊断为精神病性抑郁症的7836例患者。精神病性抑郁症指数诊断的中位年龄为49岁（四分位数范围：35-65岁），56.7%为女性。随访结束时，28.8% （95% CI: 27.7-29.9）的患者诊断为精神病或双相情感障碍。精神障碍的累计转化发生率（17.5%,95% CI: 16.6-18.4）高于双相情感障碍（14.7%,95% CI: 13.8-15.5）。在一项要求至少两次诊断记录间隔≥1年的敏感性分析中，诊断改变的总发生率降至19.0% (95% CI: 18.1-20.0)，精神障碍的相应发生率为10.0% (95% CI: 9.3-10.7)，双相情感障碍的相应发生率为9.8% （95% CI: 9.1-10.5）。诊断转换在年轻人中更为常见。结论：在瑞典，大约20%-30%在二级护理中诊断为精神病性抑郁症的患者预计将在17年内接受双相情感障碍或精神病的后续诊断。这具有重要的临床意义，因为这些疾病的预后和治疗策略不同。需要进一步的研究来确定诊断转换的风险因素，以改善早期发现和管理。

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引用次数: 0

Correction to “Systematic Multi-Trait Study of Genetic Correlation and Causality Relationships Between General Medical Conditions and Mental Disorders” 对“一般疾病与精神障碍遗传相关及因果关系的系统多性状研究”的更正

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-16 DOI: 10.1111/acps.70062

R. Nudel, M. Da Re, and M. E. Benros, “Systematic Multi-Trait Study of Genetic Correlation and Causality Relationships Between General Medical Conditions and Mental Disorders,” Acta Psychiatrica Scandinavica 152, no. 3 (2025): 236–249, https://doi.org/10.1111/acps.13825.

Since the publication of our article, we have discovered that the R script that was used to merge pairs of summary statistics datasets for analyses with LCV (ExampleRealdataScript.R, downloaded from the LCV GitHub) did not handle strand flips across the two datasets correctly; the instructions within the script recommend using summary statistics munged by LDSC (which we did, with munge_sumstats.py, removing ambiguous SNPs and checking for potential allele mismatches using the same reference file with merge-alleles for all sets of summary statistics in the study), but the R script does not take into account strand flips; in LDSC, these are handled during the LDSC analysis (hence the genetic correlation analyses were not affected). While some pairs of traits did not have this issue, mostly when they were from the same cohort (e.g. when both traits had GWASs done in iPSYCH), and, otherwise, only a relatively small number of SNPs were affected for other pairs of traits, we have repeated all the LCV analyses after modifying this script to take strand flips into account and re-merging sets of summary statistics.

This had a minor effect on the results, and the main conclusions of our study did not change. Nonetheless, the results for the pairs of traits in Table 3 in the article would change to the ones in the new Table 3 here. Only for the association between obsessive-compulsive disorder and irritable bowel syndrome do we see a change of sign for the GCP, even though the absolute size of the change was small, and the GCP is still close to zero. This result thus remains weak evidence for genetic causality for this pair of traits. We have also updated Supplementary Table S4 with the full results of the new LCV analyses after the reprocessing of the summary statistics datasets. Across all analyses, the mean of the absolute value of the difference in GCP was < 0.01. No associations that were not significant previously (q ≤ 0.05) became significant or vice versa.

Supplementary Table S4 has been replaced in the published article, together with further checks for one of the main results from the LCV analyses.

We apologize for this error.

R. Nudel， M. Da Re和M. E. Benros，“一般医学状况和精神障碍之间遗传相关性和因果关系的系统多性状研究”，《斯堪的纳维亚精神病学学报》152，第2期。3 (2025): 236-249, https://doi.org/10.1111/acps.13825.Since我们的文章发表后，我们发现，用于合并汇总统计数据集对的R脚本与LCV （ExampleRealdataScript）进行分析。R，从LCV GitHub下载)没有正确处理跨两个数据集的链翻转；脚本中的说明建议使用LDSC修改的汇总统计数据（我们使用munge_sumstats.py，删除模棱两可的snp并使用具有合并等位基因的相同参考文件检查研究中所有汇总统计数据集的潜在等位基因错配），但R脚本没有考虑到链翻转；在LDSC中，这些在LDSC分析期间处理（因此遗传相关性分析不受影响）。虽然有些性状对没有这个问题，主要是当它们来自同一队列时（例如，当两个性状在iPSYCH中都有GWASs时），否则，其他性状对只有相对较少的snp受到影响，我们在修改该脚本后重复了所有的LCV分析，考虑了链翻转并重新合并了汇总统计集。这对结果有轻微的影响，我们研究的主要结论没有改变。尽管如此，文章中表3中性状对的结果将改变为这里的新表3中的结果。只有在强迫症和肠易激综合症之间的关联中，我们才看到GCP的变化，尽管变化的绝对大小很小，GCP仍然接近于零。因此，这一结果仍然不足以证明这对性状的遗传因果关系。我们还更新了补充表S4，其中包含对汇总统计数据集重新处理后的新LCV分析的全部结果。在所有分析中，GCP差异绝对值的平均值为0.01。没有先前不显著的关联（q≤0.05）变得显著，反之亦然。已发表文章中的补充表S4已被替换，并对LCV分析的主要结果之一进行了进一步检查。我们为这个错误道歉。

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引用次数: 0

Associations of Antenatal Corticosteroids and Maternal Postpartum Mental Health—A Cohort Study 产前皮质激素与产妇产后心理健康的关系——一项队列研究

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-10 DOI: 10.1111/acps.70058

Agnes Kielgast Ladelund, Frederikke Hørdam Gronemann, Ulrik Schiøler Kesmodel, Merete Osler

<div> <section> <h3> Introduction</h3> <p>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.</p> </section> <section> <h3> Methods</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>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.</p> </section> <section> <h3> Conclusion</h3> <p>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

产前皮质类固醇治疗（ACS），给肌注给孕妇，推荐作为标准护理，当分娩前孕34周的预期。ACS因其降低新生儿死亡率和发病率的能力而被广泛认可，但由于其神经精神副作用和在心理脆弱期的时间，它可能影响孕产妇的心理健康。尽管如此，ACS与产妇产后精神障碍之间的潜在联系仍未得到充分研究。本研究旨在探讨ACS与产妇产后抑郁和其他产后精神障碍之间的可能联系。方法：这项基于登记的队列研究包括2003年至2018年期间丹麦7家医院130,235名独特女性的165,936名新生儿。从丹麦的登记资料中检索ACS给药、妊娠、出生、产后精神障碍和潜在混杂因素的数据。这些妇女在分娩后1年随访，以确定是否发生精神障碍，并通过Cox比例风险回归模型探讨与ACS的关系。这些模型按产妇ID聚类，并根据社会人口统计学、产科和精神病学协变量进行调整，以估计具有相应95%置信区间（ci）的风险比（hr）。所有模型都包括胎龄和ACS暴露之间的相互作用。结果：暴露于ACS但在分娩时或分娩后分娩的妇女与未暴露于ACS但在相似胎龄分娩的妇女相比，产后抑郁和其他产后精神障碍的风险明显更高，其hr分别为1.66（1.18-2.33）、1.50（1.03-2.19）和1.64（1.24-2.18）。相比之下，早产妇女之间的关联没有统计学意义。结论：在足月或足月分娩的妇女中，ACS暴露与母亲产后精神障碍的风险增加有关，但与早产妇女无关。足月/足月后组的风险增加可能归因于未测量的混杂因素。这些发现为ACS不太可能大幅增加早产妇女产后精神障碍的风险提供了保证，但它们也强调了对最终足月分娩的有早产威胁的妇女进行密切随访的必要性。我们的研究结果还呼吁改进ACS的注册管理，以加强未来的监测和药物安全。

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引用次数: 0

Artificial Intelligence (AI) Chatbots and Mental Health: Have We Learned Nothing From the Global Social Media Experiment? 人工智能（AI）聊天机器人与心理健康：我们从全球社交媒体实验中没有学到任何东西吗？

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-08 DOI: 10.1111/acps.70057

Søren Dinesen Østergaard

<p>What can possibly go wrong with having an online social network where friends, acquaintances, and relatives across continents can connect, correspond, share photos, and like each other's “posts”? Now, almost 20 years after Facebook was widely launched and followed by a host of competing social media (SoMe) services, the answer, unfortunately, seems to be: quite a lot! Indeed, there are credible reports of SoMe having been used for targeted misinformation of voters and persecution of vulnerable minorities [<span>1-4</span>]. In addition to these problems for democracies and minorities, there seems to be consensus that SoMe has a net-negative effect on the mental health of its users, probably driven, at least partly, by upward social comparison (i.e., “my peers lead a better life than I do”) [<span>5-13</span>]. This knowledge is now leading governments to enforce age restrictions on access to SoMe and propose reduced time spent on SoMe [<span>14, 15</span>]. In hindsight, these regulations came way too late, and the harm caused by this latency is likely both substantial and irreversible in many cases.</p><p>These days, it seems that this history is repeating itself—only with SoMe replaced by chatbots driven by generative artificial intelligence (AI chatbots). The AI chatbots have taken the world by storm led by ChatGPT from OpenAI, which has surpassed 800 million weekly users [<span>16</span>]. Unfortunately, the extremely rapid uptake of this technology has been accompanied by an increasing number of reports of vulnerable individuals experiencing severe mental health crises, for example delusions and mania—some with fatal consequences (incl. a case of murder-suicide [<span>17</span>])—alongside use of AI chatbots [<span>18-22</span>]. Although the jury is still out as to whether this represents a causal effect of AI chatbot use, the anecdotal evidence represented by the cases of mental health crises appears to be strong enough to have led OpenAI to modify ChatGPT in an attempt to make it more psychologically safe [<span>23, 24</span>]. Time will tell whether these endeavors suffice. My gut feeling is that it will be very difficult to strike the right balance between the AI chatbots being safe to use from a mental health perspective and maintaining their user appeal (and, hence, their commercial potential). This is due to an important aspect of them being appealing (their personal and appraising communication tone—sometimes referred to as “sycophancy” when obsequious) also seeming to be a central part of the mechanism driving the psychological harm they appear to cause (e.g., by validating delusional thinking or stimulating pathologically elevated mood) [<span>18-22</span>].</p><p>Some may argue that the introduction of new types of media and technologies has always led to a public “scare” regarding behavioral/psychological consequences that have since turned out to be exaggerated. However, I will argue that both SoMe and AI chatbots are so qua

拥有一个在线社交网络，让各大洲的朋友、熟人和亲戚可以联系、通信、分享照片，并为彼此的“帖子”点赞，这可能会出什么问题呢？如今，在Facebook被广泛推出并随后出现大量竞争社交媒体服务近20年之后，不幸的是，答案似乎是：相当多！事实上，有可信的报道称，一些人被用于有针对性地误导选民和迫害弱势少数群体[1-4]。除了民主国家和少数民族面临的这些问题外，人们似乎一致认为，有些人对其用户的心理健康有净负面影响，这可能至少部分是由向上的社会比较（即“我的同龄人过得比我好”）所驱动的[5-13]。这一认识现在正导致政府对接触SoMe实施年龄限制，并建议减少花在SoMe上的时间[14,15]。事后看来，这些规定出台得太晚了，在许多情况下，这种延迟造成的伤害可能是巨大的，而且是不可逆转的。如今，这段历史似乎正在重演——只不过其中一些被由生成式人工智能（AI chatbots）驱动的聊天机器人所取代。人工智能聊天机器人以OpenAI的ChatGPT为首风靡全球，每周用户超过8亿。不幸的是，随着这项技术的迅速普及，越来越多的报道称，弱势群体经历了严重的精神健康危机，例如妄想和狂躁，其中一些具有致命的后果（包括一起谋杀-自杀案件），以及使用人工智能聊天机器人[18-22]。尽管这是否代表人工智能聊天机器人使用的因果效应还没有定论，但心理健康危机案例所代表的轶事证据似乎足够强大，足以促使OpenAI修改ChatGPT，试图使其在心理上更安全[23,24]。时间将证明这些努力是否足够。我的直觉是，很难在人工智能聊天机器人从心理健康的角度安全使用和保持它们的用户吸引力（以及它们的商业潜力）之间取得适当的平衡。这是由于他们吸引人的一个重要方面（他们的个人和评价的沟通语气-有时被称为“谄媚”当谄媚）似乎也是驱动他们似乎造成心理伤害的机制的核心部分（例如，通过验证妄想思维或刺激病态高涨的情绪）[18-22]。有些人可能会争辩说，新媒体和新技术的引入总是会导致公众对行为/心理后果的“恐慌”，而这些后果后来被证明是被夸大了。然而，我想说的是，人工智能和人工智能聊天机器人与过去的媒体和技术在本质上是如此不同，以至于在这两种情况下的恐慌是值得的——甚至可能低估了风险。具体来说，关于SoMe，与之前的所有媒体不同，非常可见/可访问的好友、粉丝、点赞和转发数量允许进行直接、定量的社交比较。另一方面，人工智能聊天机器人的独特之处在于，它们将无缝的、高度拟人化的用户界面（包括令人信服的语音模式）和谄媚相结合。我认为，从心理健康的角度来看，两者都可能是灾难的根源，但其后果却截然不同，这与上面概述的它们的独特特征相一致。事实上，虽然社交媒体似乎主要导致“内化”症状（如抑郁、焦虑和心理健康下降）[5-13]，但人工智能聊天机器人似乎对“生产性”症状（如妄想和躁狂）的贡献更大[18-22]。不幸的是，尽管这些倾向有些相反，但它们极不可能相互抵消。如果人工智能聊天机器人确实会对用户的心理健康产生负面影响，那么这篇社论标题中提出的问题就变得紧迫了。我们还没有从全球社交媒体实验中学到什么吗？不幸的是，答案似乎是响亮的“不”。事后看来，在近二十年的时间里，允许一些人造成心理伤害的一个关键因素是，在全球范围内推广之前，没有要求进行心理安全测试——本质上是使这成为一个在全球范围内不受控制的实验。在人工智能聊天机器人的案例中，我们现在似乎正在目睹完全相同的一系列事件。事实上，心理安全测试似乎主要是在用户付钱之后进行的[18-22]。不幸的是，在心理安全测试等要求方面，对开发人工智能聊天机器人的公司（主要是美国公司）进行更严格的监管几乎没有什么希望——恰恰相反。因此，我们似乎仍然掌握在科技公司的手中，其中一家据称曾将“快速行动，打破常规”作为b[26]早期的内部座右铭。不幸的是，考虑到人工智能聊天机器人在全球的推广，很难看出改变这一座右铭会导致这个行业的风险偏好发生变化。这篇社论没有得到特别的资助。Søren Dinesen Østergaard获得2020年灵北基金会青年研究员奖。此外,s.dØ。拥有/曾经拥有股票代码为DKIGI、IAIMWC、SPIC25KL和WEKAFKI的共同基金单位，拥有/曾经拥有股票代码为BATE、TRET、QDV5、QDVH、QDVE、SADM、IQQH、USPY、EXH2、2B76、IS4S、OM3X、EUNL和SXRV的交易所交易基金单位。数据共享不适用于本文，因为在当前研究中没有生成或分析数据集。

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引用次数: 0

Correction to “In the Assessment of Childhood Maltreatment and Cognitive Function in Bipolar Disorder All Variables Should Be Taken Into Consideration” 更正“在评估儿童虐待和双相情感障碍的认知功能时，应考虑所有变量”。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-08 DOI: 10.1111/acps.70046

A. M. Fernandes, E. S. de Lima, T. C. Ferreira, G. C. Pardi, F. G. de Matos e Souza, and L. W. Bisol, “In the Assessment of Childhood Maltreatment and Cognitive Function in Bipolar Disorder All Variables Should Be Taken Into Consideration,” Acta Psychiatrica Scandinavica 152, no. 5 (2025): 397–398, https://doi.org/10.1111/acps.70009.

The reference 1 was incorrect.

The correct reference 1 should be: “Fares-Otero, N.E., Pérez-Ramos, A., Lopez-Escribano, R., Martin-Parra, S., Alameda, L., Halligan, S.L., Miskowiak, K.W. and Vieta, E. (2025), Childhood Maltreatment and Cognitive Functioning in Bipolar Disorder: A Systematic Review and Meta-Analysis. Acta Psychiatr Scand. https://doi.org/10.1111/acps.13813”.

Thank you for the opportunity for the correct the information.

A. M. Fernandes, e . S. de Lima， T. C. Ferreira， G. C. Pardi， F. G. de Matos e Souza， L. W. Bisol，“在双相情感障碍儿童虐待和认知功能的评估中应考虑所有变量”，《精神病学杂志》152，第2期。5 (2025): 397-398, https://doi.org/10.1111/acps.70009.The参考文献1不正确。正确的参考文献1应该是：“Fares-Otero, n.e., prez - ramos， A., Lopez-Escribano， R., martinparra， S., Alameda， L., Halligan, s.l., Miskowiak， K.W.和Vieta， E.(2025)，儿童虐待与双相情感障碍的认知功能：系统回顾和荟萃分析。精神病学杂志。https://doi.org/10.1111/acps.13813”。感谢您给我这个机会更正我的信息。

引用次数: 0

Time Trends in the Mortality Gap for Individuals With Mental Disorders in Denmark: A Population-Based Cohort Study Over 2010–2023 丹麦精神障碍患者死亡率差距的时间趋势：2010-2023年基于人群的队列研究

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-12-05 DOI: 10.1111/acps.70056

Oleguer Plana-Ripoll, Merete Nordentoft, Mette Lise Lousdal, Magnus Elias Kjærsgaard Tarp, Natalie C. Momen

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.

背景：精神障碍患者与一般人群之间的死亡率差距是公认的。本研究旨在全面调查精神障碍患者的死亡率及其死亡率差距如何随时间变化。方法：我们使用全国行政数据进行了一项基于人群的队列研究，包括2010年至2023年期间居住在丹麦的所有1-99岁人群。在丹麦医院的登记册中确定了精神障碍，并将其分为10组。有关死亡率的信息来自人口登记册，死亡原因在自然原因和外因这两大类中分为11组。对于每种特定的精神障碍，我们通过使用被诊断者的性别和年龄分布（5岁年龄组）的直接标准化来估计被诊断者和一般人群的死亡率。所有分析均在五个日历期间（2010-2012年、2013-2015年、2016-2018年、2019-2021年和2022-2023年）进行。结果：共随访7133833人，随访时间7800万人年。2010-2023年精神障碍患者的死亡率为每1000人年19.8例死亡（95% CI: 19.8-19.9），而标准化死亡率（SMR）为2.15（2.14-2.16）。随着时间的推移，普通人群和精神障碍患者的死亡率都在下降，而smr从2010-2012年的2.47（2.44-2.50）下降到2022-2023年的2.32（2.28-2.36）。然而，这些改善仅在男性中观察到，并且仅针对某些疾病（包括抑郁和焦虑），而不是针对其他疾病（包括精神分裂症或物质使用障碍）。讨论：尽管精神障碍患者的死亡率有所改善，但这还不足以缩小与一般人群的死亡率差距，特别是对于最严重的疾病。需要更多的主动行动，现有的主动行动需要得到加强。

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引用次数: 0