Acta Psychiatrica Scandinavica最新文献

{"title":"The Impact of Preexisting Severe Mental Disorders on Cancer Mortality: A Systematic Review and Meta-Analysis","authors":"Nikoline Riis,&nbsp;Malene Vestergaard,&nbsp;Mette Asbjoern Neergaard,&nbsp;Jan Alsner,&nbsp;Jesper Grau Eriksen,&nbsp;Poul Videbech,&nbsp;Anna Mygind,&nbsp;Søren Paaske Johnsen,&nbsp;Jan Brink Valentin,&nbsp;Louise Elkjær Fløe","doi":"10.1111/acps.70054","DOIUrl":"10.1111/acps.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>People with severe mental disorders (SMD) face a significantly lower life expectancy compared to people without SMD. Studies have reported divergent results concerning cancer-specific mortality. Therefore this systematic review and meta-analysis aimed to assess the cancer-specific mortality for people with preexisting SMD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted across PubMed, Embase, Psycinfo, and Scopus for studies published since January 2003. Inclusion criteria targeted adult cancer patients with a known SMD diagnosis prior to their cancer diagnosis. Two authors independently screened records based on predefined criteria, resolving discrepancies through discussion. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale. A random effects model was employed to conduct the analysis, with heterogeneity across the studies quantified using the <i>I</i>\u0000 ² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search yielded 4736 records, of which 25 studies met the eligibility criteria. Findings consistently indicated higher cancer-specific mortality among patients with preexisting SMD, with a 1.37 (95% CI: 1.30–1.44) higher relative risk of cancer-specific mortality for patients with preexisting SMD. The highest mortality rates were found among patients with schizophrenia and other psychosis with a relative cancer mortality risk at 1.47 (95% CI: 1.33–1.63).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review and meta-analysis highlighted a concerning higher relative cancer-specific mortality risk for patients with preexisting SMD. These findings underscore the need for integrated healthcare approaches addressing both cancer treatment and mental health to improve outcomes for this vulnerable population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 3","pages":"158-178"},"PeriodicalIF":5.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601417","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}

{"title":"Comparative Efficacy and Tolerability of Multiple Antipsychotics Across Varying Doses for Neuropsychiatric Symptoms of Dementia Including Alzheimer's Disease: A Dose–Response Model-Based Network Meta-Analysis","authors":"Itsuki Terao,&nbsp;Wakako Kodama","doi":"10.1111/acps.70051","DOIUrl":"10.1111/acps.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antipsychotics are widely used for neuropsychiatric symptoms (NPSs) in dementia including Alzheimer's disease (AD), yet balancing efficacy and safety remains a major clinical challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Relevant randomized controlled trials were identified through a comprehensive literature search of CENTRAL, PubMed, CINAHL, and ClinicalTrials.gov. We conducted a dose–response model-based network meta-analysis to evaluate the efficacy as the change in overall NPS severity and the tolerability as treatment discontinuation due to adverse events of aripiprazole, brexpiprazole, risperidone, quetiapine and olanzapine at varying doses in patients with dementia including AD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty trials involving 5844 participants were included. Most of the included antipsychotics exhibited a generally positive dose–response relationship with respect to both efficacy and tolerability, except for olanzapine, which showed a bell-shaped curve in terms of efficacy. Only aripiprazole 10 mg, brexpiprazole 1–2.5 mg, risperidone 1–2 mg, and olanzapine 2.5–5 mg were significantly more effective than placebo. Tolerability did not significantly decrease compared to placebo for aripiprazole up to 10 mg, brexpiprazole up to 3 mg, risperidone up to 1 mg, olanzapine up to 2.5 mg and at 15 mg, and quetiapine up to 200 mg. Furthermore, significant differences in efficacy and tolerability were observed between certain doses of several antipsychotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aripiprazole 10 mg, brexpiprazole 1–2.5 mg, risperidone 1 mg, and olanzapine 2.5 mg were both effective and well tolerated, indicating their potential as favorable treatment options. As the present model incorporates several sources of uncertainty, its findings should be interpreted with caution and regarded as a provisional framework to support clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 2","pages":"82-94"},"PeriodicalIF":5.0,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585402","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}

{"title":"Clinician Assessed Rates of PTSD and Complex PTSD in a Medical-Rehabilitation Sample of Active-Duty Military Personnel in the Armed Forces of Ukraine","authors":"Philip Hyland,&nbsp;Mark Shevlin,&nbsp;Thanos Karatzias,&nbsp;Kristina Bondjers,&nbsp;Anna Scherbakova,&nbsp;Oksana Sulaieva,&nbsp;Anastasiia Bibikova,&nbsp;Olexandr Dudin,&nbsp;Anton Savchenko,&nbsp;Kseniia Voznitsyna,&nbsp;Victor Dosenko,&nbsp;Dmytro Martsenkovskyi","doi":"10.1111/acps.70050","DOIUrl":"10.1111/acps.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Millions of people have served in the Armed Forces of Ukraine (AFU) since Russia's invasion in 2014, but there is currently no information about the prevalence of posttraumatic stress disorder (PTSD) in this population. The main purpose of this study was to estimate rates of ICD-11 PTSD and Complex PTSD (CPTSD), and comorbidity with major depression, in a sample of active-duty, combat-exposed AFU military personnel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical interviews were conducted with 590 soldiers recruited from military hospitals and rehabilitation centers in Ukraine. All were trauma-exposed during military operations. PTSD and CPTSD were diagnosed using the International Trauma Interview, and a current episode of major depression was diagnosed using the Mini-International Neuropsychiatric Interview.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 67.4% of soldiers were diagnosed with ICD-11 PTSD or CPTSD, with 45.9% being diagnosed with PTSD and 21.5% with CPTSD. Additionally, 34.4% were diagnosed with major depression, and comorbidity with PTSD (45.0%) and CPTSD (51.2%) was high. Elevated rates of PTSD were observed for current smokers and those who were currently consuming alcohol, while elevated rates of CPTSD were observed for officers (versus enlisted soldiers) and those recruited from rehabilitation facilities (vs. general hospitals).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although not representative of the entire AFU population, these results imply that hundreds of thousands of soldiers (and veterans) in Ukraine are likely experiencing clinically significant posttraumatic distress related to their combat experiences. Results are discussed in the context of finding scalable approaches to addressing this mental health challenge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 2","pages":"133-139"},"PeriodicalIF":5.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562045","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":"Clinical Judgment and the Architecture of Reasoning in Psychiatry","authors":"Melvin G. McInnis,&nbsp;J. Raymond DePaulo","doi":"10.1111/acps.70047","DOIUrl":"10.1111/acps.70047","url":null,"abstract":"&lt;p&gt;Across the history of medicine, one principle has remained constant: the irreplaceable intelligence of clinical judgment. From Hippocrates onward the understanding of how illness unfolds within the life of the person who suffers was a priority. In 1913, the French clinician Anatole Chauffard described prognosis as the vital bridge between diagnosis and treatment; he defined medicine's essential triad: “to know, to foresee, to act” [&lt;span&gt;1&lt;/span&gt;]. Two decades later, Walter Pagel traced this lineage to the Greek concept of &lt;i&gt;physis&lt;/i&gt;, the individual's self-regulating nature and capacity for recovery [&lt;span&gt;2&lt;/span&gt;]. The physician's art lay in discerning this natural history of the person and in foreseeing the turning points. Pagel warned that as medicine advanced toward the analytic precision of anatomy and classification, the interpretive art of reading the individual's &lt;i&gt;physis&lt;/i&gt;, the capacity to “know, foresee, and act” through understanding the living course of illness risked being supplanted by a systematic approach of lesions and causal models [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Nowhere has this warning proven more prescient than in psychiatry. While the rest of medicine has advanced toward increasingly precise forms of personalized care, guided by pathology, genetics, and imaging, psychiatry has struggled with the erosion of its epistemic core. In a discipline where subjective experience, phenomenology, meaning, and values intersect with (an as yet unknown) biology, the displacement of clinical judgment by checklist-based classification is problematic methodologically, and is a moral diminishment of the person at the center of care.&lt;/p&gt;&lt;p&gt;In this issue Fava and Guidi note that clinical judgment is “perceived as an intuitive art that is going to be replaced by growing technology and artificial intelligence.” [&lt;span&gt;3&lt;/span&gt;] Modern medicine achieved unparalleled analytic power through biology, measurement, and classification, but often at the cost of understanding the singular human being. In psychiatry, where meanings and values shape and are shaped by biology [&lt;span&gt;4&lt;/span&gt;], this loss is particularly acute.&lt;/p&gt;&lt;p&gt;The rise of categorical diagnostic systems, culminating in the &lt;i&gt;DSM&lt;/i&gt; and &lt;i&gt;ICD&lt;/i&gt;, transformed psychiatry into a science of reliability [&lt;span&gt;5&lt;/span&gt;]. By operationalizing definitions, these systems provided standards for medical care, enabled epidemiologic research and public-health planning. Psychiatric disorders were included in the Global Burden of Disease studies, and demonstrated that mental illness accounted for a disproportionate share of years lived with disability worldwide [&lt;span&gt;6&lt;/span&gt;]. In that respect, operational criteria democratized psychiatry: they gave policymakers, insurers, and researchers a common language for quantifying need. These are the advantages and purpose of a reliable classification system.&lt;/p&gt;&lt;p&gt;Yet the very success of this approach exposed its limits. The rules that standardized diagno","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":"3-5"},"PeriodicalIF":5.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562089","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":"Association Between Metabolic Syndrome, Obesity, and Cognitive Performances in Individuals With Bipolar Disorders: Cross-Sectional and Longitudinal Analyses in the FACE-BD Cohort","authors":"I. Palimaru,&nbsp;B. Etain,&nbsp;M. Leboyer,&nbsp;Y. Dansou,&nbsp;P. Favre,&nbsp;S. Gard,&nbsp;V. Aubin,&nbsp;F. Bellivier,&nbsp;R. Belzeaux,&nbsp;P. Courtet,&nbsp;C. Dubertret,&nbsp;E. Haffen,&nbsp;A. Lefrere,&nbsp;P. M. Llorca,&nbsp;E. Olié,&nbsp;M. Polosan,&nbsp;L. Samalin,&nbsp;R. Schwan,&nbsp;the FondaMental Academic Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators,&nbsp;P. Roux,&nbsp;O. Godin","doi":"10.1111/acps.70048","DOIUrl":"10.1111/acps.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic syndrome (MetS) has been suggested to be associated with cognitive impairments in bipolar disorder (BD); however, studies are limited by small sample sizes or cross-sectional design. Our objective is to evaluate the cross-sectional and longitudinal associations between MetS and cognitive performances in a large cohort of individuals with BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>1175 individuals with a DSM-IV diagnosis of BD were included from the FACE-BD cohort, assessed with a standardized battery of clinical and neuropsychological tests and followed up with a cognitive retest at 2 years for a subsample (<i>n</i> = 367). A global cognitive index was created by using a Principal Component Analysis. Associations between MetS and cognitive performances at baseline were explored using multiple analyses of covariance and linear mixed models were used for longitudinal data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of MetS was 21.5% in this sample. Multivariable analyses identified associations between MetS and poorer cognitive performance in the cross-sectional analysis, independently of age, gender, education level, psychotropic treatments, and comorbidities. Specifically, individuals with MetS showed poorer results (global cognitive index, cognitive flexibility, inhibition, and verbal memory). After adjustment, the longitudinal analysis showed no change in the global cognitive index at year 2 and no time × metabolic syndrome interaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggest that MetS is cross-sectionally, but not longitudinally, associated with poorer cognitive performances in BD. This study highlights the importance of systematically and accurately screening for metabolic abnormalities in individuals with BD, and screening for cognitive deficit especially in individuals with MetS. Our results suggest that MetS is not a risk factor for cognitive decline during the follow-up, but further longitudinal studies are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 2","pages":"108-121"},"PeriodicalIF":5.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562056","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":"Resilience in Bipolar Disorder Compared to Clinical and Non-Clinical Populations: A Systematic Review and Meta-Analysis","authors":"Derek Clougher,&nbsp;Michele De Prisco,&nbsp;Brisa Solé,&nbsp;Laura Montejo,&nbsp;Maria Serra-Navarro,&nbsp;Maria Florencia Forte,&nbsp;Patricia Camprodon-Boadas,&nbsp;Elena de la Serna,&nbsp;Vincenzo Oliva,&nbsp;Sara Martin-Parra,&nbsp;Jose Sánchez-Moreno,&nbsp;Benedikt L. Amann,&nbsp;Marina Garriga,&nbsp;Norma Verdolini,&nbsp;Marta Ribases,&nbsp;Kamilla Miskowiak,&nbsp;Anabel Martínez-Aran,&nbsp;Eduard Vieta,&nbsp;Silvia Amoretti,&nbsp;Carla Torrent","doi":"10.1111/acps.70042","DOIUrl":"10.1111/acps.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Resilience is present in both clinical and non-clinical populations; yet, there is a paucity of literature examining its role in bipolar disorder (BD). The goal of the present systematic review and meta-analysis was to substantiate the extant literature investigating resilience in BD in comparison to clinical and non-clinical populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>PubMed/MEDLINE, PsycINFO, and Scopus were systematically searched from inception to August 8th, 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-eight studies using a validated resilience scale with a total of 3094 people with BD, 4100 healthy controls, and 1768 with other mental diagnoses were included in the systematic review, and 21 were analyzed in a random effects meta-analysis. A statistically significant result with a medium effect (SMD = −0.787, <i>p</i> &lt; 0.001) indicated that people with BD reported lower levels of resilience than healthy controls. Similarly, patients with BD showed higher levels of resilience than patients with schizophrenia (SCZ) (SMD = 0.336, <i>p</i> = 0.013). No significant differences were found between BD and major depressive disorder (MDD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings should be interpreted with caution due to the high heterogeneity observed and methodological challenges in the definition and measurement of resilience. Future research should aim to better characterize resilience in BD by improving its assessment as a standardized element of clinical evaluation. This will provide a basis for strategies to reduce the burden of this chronic condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":"6-23"},"PeriodicalIF":5.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493931","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":"Correction to “Homocysteine Levels and Glucose Metabolism in Non-Obese, Non-Diabetic Chronic Schizophrenia”","authors":"","doi":"10.1111/acps.70045","DOIUrl":"10.1111/acps.70045","url":null,"abstract":"<p>D. C. Henderson, P. M. Copeland, D. D. Nguyen, C. P. Borba, C. Cather, A. Eden Evins, O. Freudenreich, L. Baer, and D. C. Goff, “Homocysteine Levels and Glucose Metabolism in Non-Obese, Non-Diabetic Chronic Schizophrenia,” <i>Acta Psychiatrica Scandinavica</i> 113 (2006): 121–125. https://doi.org/10.1111/j.1600-0447.2005.00621.x.</p><p>The author's name, A. E. Evins, has been corrected to A. E. Evins.</p><p>We apologize for this error.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450199","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":"Correction to “A Double-Blind, Placebo-Controlled Trial of Rosiglitazone for Clozapine-Induced Glucose Metabolism Impairment in Patients with Schizophrenia”","authors":"","doi":"10.1111/acps.70044","DOIUrl":"10.1111/acps.70044","url":null,"abstract":"<p>D. C. Henderson, X. Fan, B. Sharma, P. M. Copeland, C. P. Borba, R. Boxill, O. Freudenreich, C. Cather, A. Eden Evins, and D. C. Goff, “A Double-Blind, Placebo-Controlled Trial of Rosiglitazone for Clozapine-Induced Glucose Metabolism Impairment in Patients with Schizophrenia,” <i>Acta Psychiatrica Scandinavica</i> 119 (2009): 457–465. https://doi.org/10.1111/j.1600-0447.2008.01325.x.</p><p>The author's name, A. Eden Evins, has been corrected to A. E. Evins.</p><p>We apologize for this error.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436601","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":"Risk of Stroke in Patients With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder: A Cohort Study of 183,504 Subjects","authors":"Mao-Hsuan Huang,&nbsp;Chih-Ming Cheng,&nbsp;Ju-Wei Hsu,&nbsp;Ya-Mei Bai,&nbsp;Tung-Ping Su,&nbsp;Cheng-Ta Li,&nbsp;Shih-Jen Tsai,&nbsp;Yee-Lam E. Chan,&nbsp;Mu-Hong Chen","doi":"10.1111/acps.70043","DOIUrl":"10.1111/acps.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Major psychiatric disorder, including schizophrenia, bipolar disorder, and major depressive disorder, has been individually associated with increased risk of stroke. However, few studies have directly compared the stroke risk across these diagnostic groups within a unified cohort framework while accounting for stroke subtypes and relevant confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Taiwan's National Health Insurance Research Database, we identified 30,945 patients with schizophrenia, 30,360 with bipolar disorder, 30,447 with major depressive disorder, and 91,752 age-matched controls without psychiatric illness between 2001 and 2009. Participants were followed until death or the end of 2011. Cox regression models were used to estimate the hazard ratio (HR) for ischemic and hemorrhagic stroke, adjusting for potential confounding factors. Sensitivity analyses were conducted by excluding stroke events occurring within the first 1 or 3 years of psychiatric diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All three psychiatric groups exhibited significantly higher risks of ischemic and hemorrhagic stroke compared with controls. Stroke risk remained consistently elevated across age and sex strata for all psychiatric groups. Greater cumulative exposure to antidepressants was associated with reduced stroke risk across all three disorders; antipsychotics showed protective associations in schizophrenia and bipolar disorder, non-lithium mood stabilizers were protective only in bipolar disorder, and lithium showed no significant association with stroke risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Schizophrenia, bipolar disorder, and major depressive disorder are independently associated with increased stroke risk. These findings highlight the need for integrated vascular risk monitoring in psychiatric care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 1","pages":"54-64"},"PeriodicalIF":5.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399127","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":"Predicting Response to Pro-Cognitive Interventions in Mood Disorders: A Systematic Review by the International Society for Bipolar Disorders Targeting Cognition Task Force.","authors":"Dimosthenis Tsapekos, Michail Kalfas, Johanna M Schandorff, Caterina Del Mar Bonnin, Christopher R Bowie, Vicent Balanzá-Martínez, Katherine E Burdick, Andre F Carvalho, Annemieke Dols, Katie Douglas, Peter Gallagher, Gregor Hasler, Lars V Kessing, Hanne L Kjærstad, Beny Lafer, Kathryn E Lewandowski, Carlos López-Jaramillo, Anabel Martinez-Aran, Roger S McIntyre, Richard J Porter, Scot E Purdon, Ayal Schaffer, Paul R A Stokes, Tomiki Sumiyoshi, Ivan J Torres, Tamsyn E Van Rheenen, Lakshmi N Yatham, Jeff Zarp, Allan H Young, Eduard Vieta, Kamilla W Miskowiak","doi":"10.1111/acps.70038","DOIUrl":"https://doi.org/10.1111/acps.70038","url":null,"abstract":"<p><strong>Introduction: </strong>Major depressive disorder (MDD) and bipolar disorder (BD) are often associated with persistent cognitive deficits that impair psychosocial functioning. While pro-cognitive interventions show promise, trial findings are inconsistent, potentially due to baseline factors influencing treatment response. This systematic review summarizes evidence on pre-treatment characteristics associated with cognitive improvement and offers methodological recommendations.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed/MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception to February 28, 2025. Eligible studies included primary or secondary analyses of randomized controlled trials (RCTs) investigating predictors of cognitive response to pro-cognitive interventions in MDD and/or BD. Two researchers independently conducted study selection and risk of bias assessments. Findings were synthesized qualitatively.</p><p><strong>Results: </strong>Forty studies (N = 3864) were identified, covering pharmacological treatments (k = 20; N = 2299), psychological therapies (k = 16; N = 1165), brain stimulation (k = 2; N = 168), and physical activity (k = 2; N = 232). Poorer baseline cognitive performance was the most consistent predictor of greater cognitive improvement, though the direction of the effect was not entirely uniform across all studies. Baseline depression severity showed no significant association with cognitive outcomes. Age, education, sex, IQ, diagnosis, and medication status were similarly non-predictive. Risk of bias was high in 77% of studies, mainly due to deviations from specified outcomes, poor randomization processes, and inconsistent handling of missing data. Considerable heterogeneity in interventions, outcome measures, and sample characteristics limited replicability and precluded meta-analysis.</p><p><strong>Conclusion: </strong>Poorer baseline cognition emerged as the most reliable predictor of greater cognitive improvement across interventions. More rigorous, well-powered studies are needed to replicate these findings and identify robust predictors to guide personalized pro-cognitive treatment approaches in mood disorders.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285158","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}