Acta Psychiatrica Scandinavica最新文献_第4页

Psychotic or Not, Mania Hurts: A 5-Year Cohort Study With a Spotlight on the Non-Psychotic Subtype and Mixed Features 精神病性或非精神病性躁狂伤害：一项针对非精神病性亚型和混合特征的5年队列研究。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-30 DOI: 10.1111/acps.70049

Helena Andreu, Anna Giménez-Palomo, Luis Olivier, Iñaki Ochandiano, Òscar de Juan, Tabatha Fernández-Plaza, Sergi Salmerón, Lluc Colomer, Eduard Vieta, Isabella Pacchiarotti

Introduction

Psychotic symptoms are frequent during acute episodes of bipolar disorder (BD), particularly in mania, and are traditionally considered a marker of greater severity and worse prognosis. However, data comparing psychotic and nonpsychotic mania remain limited and inconsistent.

Objectives

This study aimed to retrospectively examine clinical, therapeutical and 3-year outcome differences between patients hospitalized for mania with and without psychotic symptoms.

Methods

We included all patients admitted for a manic episode to the acute psychiatry unit at Hospital Clínic of Barcelona between 2015 and 2019 (n = 277). Data were extracted from medical records. Patients were followed for 3 years to assess psychiatric emergency department (PED) visits and readmissions. Functional outcomes were also analyzed in the BD subgroup (n = 234). Descriptive statistics and survival analyses were used.

Results

Psychotic symptoms were present in 73.6% of the patients and were associated with younger age (p < 0.001), earlier onset (p = 0.020), poorer insight (p < 0.001), higher cannabis use (p = 0.018) and manic predominant polarity (p = 0006). Non-psychotic patients had more previous admissions for depressive episodes (p = 0.003), more previous mixed episodes (p = 0.006) and suicide attempts (p = 0.002). No significant differences were found in PED visits or readmissions in the next 3 years. Logistic regression identified the number of previous mixed-episode-related admissions as a significant predictor of readmissions (p = 0.041), while psychotic symptoms were not associated with either outcome.

Conclusions

While psychotic and non-psychotic mania show clinical and therapeutical differences, psychosis may not predict short- to medium-term outcomes. Non-psychotic mania—which is associated with depressive polarity, mixed features and suicidal behaviour—may indicate a clinically relevant and therapeutically challenging but underrecognized subgroup. These findings call for a nuanced comprehension of the impact of psychosis in mania and multidimensional approaches.

精神症状在双相情感障碍（BD）急性发作期间很常见，特别是在躁狂中，传统上被认为是更严重和更差预后的标志。然而，比较精神病性和非精神病性躁狂的数据仍然有限且不一致。目的：本研究旨在回顾性检查伴有和不伴有精神病性症状的躁狂症住院患者的临床、治疗和3年预后差异。方法：我们纳入了2015年至2019年期间在巴塞罗那Clínic医院急性精神科收治的所有躁狂发作患者（n = 277）。数据从医疗记录中提取。患者随访3年，评估精神科急诊科（PED）就诊和再入院情况。还分析了BD亚组的功能结局（n = 234）。采用描述性统计和生存分析。结果：精神病症状出现在73.6%的患者中，并且与年龄的年轻有关(p结论：虽然精神病性和非精神病性躁狂症表现出临床和治疗上的差异，但精神病可能不能预测中短期结局。非精神病性躁狂——与抑郁极性、混合特征和自杀行为相关——可能表明一个临床相关和治疗上具有挑战性但未被充分认识的亚群。这些发现要求细致入微地理解躁狂症中精神病的影响和多维方法。

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引用次数: 0

No Effect of Low-Dose Aspirin Versus Placebo as Add-On Treatment in Bipolar Disorder—Results From a Randomised Controlled Trial (the A-Bipolar RCT) 低剂量阿司匹林与安慰剂作为双相情感障碍的附加治疗没有效果——来自一项随机对照试验（a -Bipolar RCT）的结果。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-30 DOI: 10.1111/acps.70055

Caroline Fussing Bruun, Helle B. Krogh, Jeff Zarp, Julie Ravneberg Stokholm, Julie Lyng Forman, Kamilla Woznica Miskowiak, Annamaria Giraldi, Maj Vinberg, Maria Faurholt-Jepsen, Lars Vedel Kessing

Introduction

Robust evidence associates immunoinflammatory dysfunction and bipolar disorder (BD), with immune dysregulation present in patients newly diagnosed with BD. This suggests that anti-inflammatory agents, like low-dose aspirin (LDA), might be repurposed in the treatment of early-stage BD. Building on pharmacoepidemiologic and meta-analytic evidence, we conducted the first randomised controlled trial (RCT) testing the effects of add-on LDA in patients with newly diagnosed BD. We hypothesised that add-on treatment with LDA would reduce mood instability (MI), activity instability (AI), and depression severity.

Methods

In this parallel group, triple-blind, superiority RCT, patients newly diagnosed with BD, recruited from a public outpatient mood disorder clinic in the Capital Region of Denmark, were randomised 1:1 to 150 mg acetylsalicylic acid or placebo by an independent third party. The primary outcome was average MI at 6-month follow-up, assessed by the Root Mean Square of Successive Differences (RMSSDs) method. Secondary outcomes included average AI, assessed by the RMSSD method, and change in depressive symptoms, assessed with the 6-item Hamilton Depression Rating Scale, at 6 months. Tertiary outcomes included sleep variability, cognition, manic symptoms and questionnaires at 6 months.

Results

Two hundred fifty patients were randomised from January 20, 2022, to May 30, 2024, with the last follow-up on November 18, 2024. Analyses included data from 240 patients (120 received placebo; 120 LDA), with a mean of 108 (SD = 57) daily mood registrations. The estimated treatment difference for MI was 0.022 (95% CI: −0.056 to 0.1, p = 0.58) for LDA compared to placebo, indicating no clinically relevant difference. No beneficial effects of LDA were found across secondary or tertiary outcomes. Methodologically, randomisation and blinding were successful, and serum-thromboxane B2 levels confirmed high adherence to LDA.

Conclusions

Low-dose aspirin did not demonstrate any benefit on MI or on secondary or tertiary outcomes in patients with newly diagnosed BD.

Clinical Registration

Clinicaltrials.gov registration number: NCT05035316

作品简介:强有力的证据表明，免疫炎症功能障碍和双相情感障碍（BD）与新诊断为双相情感障碍的患者存在免疫失调。这表明，抗炎药物，如低剂量阿司匹林（LDA），可能会被重新用于治疗早期双相情感障碍。我们进行了第一项随机对照试验（RCT），测试了附加LDA对新诊断的双相障碍患者的影响。我们假设附加LDA治疗可以减少情绪不稳定（MI）、活动不稳定（AI）和抑郁严重程度。方法：在这个平行组中，三盲，优势随机对照试验，从丹麦首都地区的一家公共门诊情绪障碍诊所招募的新诊断为双相障碍的患者，由独立第三方按1:1随机分配到150 mg乙酰水杨酸或安慰剂。主要终点是6个月随访时的平均心肌梗死，采用连续差异均方根（RMSSDs）方法评估。次要结局包括6个月时RMSSD方法评估的平均AI，以及6项汉密尔顿抑郁评定量表评估的抑郁症状变化。第三阶段结局包括睡眠变异性、认知、躁狂症状和6个月时的问卷调查。结果：从2022年1月20日至2024年5月30日随机抽取250例患者，最后一次随访时间为2024年11月18日。分析包括240例患者的数据（120例接受安慰剂；120例LDA），平均每天108例（SD = 57）情绪登记。与安慰剂相比，LDA治疗MI的估计治疗差异为0.022 (95% CI: -0.056至0.1,p = 0.58)，表明无临床相关差异。在二级或三级结局中没有发现LDA的有益效果。在方法学上，随机化和盲法是成功的，血清血栓素B2水平证实了LDA的高依从性。结论：低剂量阿司匹林对新诊断的bd患者的心肌梗死或二级或三级结局没有任何益处。临床注册：Clinicaltrials.gov注册号：NCT05035316。

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引用次数: 0

The Impact of Preexisting Severe Mental Disorders on Cancer Mortality: A Systematic Review and Meta-Analysis 先前存在的严重精神障碍对癌症死亡率的影响：一项系统回顾和荟萃分析。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-25 DOI: 10.1111/acps.70054

Nikoline Riis, Malene Vestergaard, Mette Asbjoern Neergaard, Jan Alsner, Jesper Grau Eriksen, Poul Videbech, Anna Mygind, Søren Paaske Johnsen, Jan Brink Valentin, Louise Elkjær Fløe

Purpose

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.

Methods

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 ² statistic.

Results

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).

Conclusion

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.

目的：与没有严重精神障碍的人相比，患有严重精神障碍（SMD）的人的预期寿命明显较低。研究报告了关于癌症特异性死亡率的不同结果。因此，本系统综述和荟萃分析旨在评估先前存在的SMD患者的癌症特异性死亡率。方法：综合检索PubMed、Embase、Psycinfo和Scopus自2003年1月以来发表的研究。纳入标准针对的是在癌症诊断前已知SMD诊断的成年癌症患者。两位作者根据预定义的标准独立筛选记录，通过讨论解决差异。使用纽卡斯尔-渥太华量表进行数据提取和质量评估。采用随机效应模型进行分析，采用I2统计量量化各研究的异质性。结果：检索到4736条记录，其中25项研究符合入选标准。研究结果一致表明，先前存在的SMD患者的癌症特异性死亡率更高，先前存在的SMD患者的癌症特异性死亡率相对风险高1.37 （95% CI: 1.30-1.44）。精神分裂症和其他精神病患者的死亡率最高，相对癌症死亡风险为1.47 （95% CI: 1.33-1.63）。结论：本综述和荟萃分析强调了先前存在的SMD患者较高的相对癌症特异性死亡风险。这些发现强调需要综合医疗方法解决癌症治疗和心理健康，以改善这一弱势群体的结果。

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引用次数: 0

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 不同剂量的多种抗精神病药物对包括阿尔茨海默病在内的痴呆神经精神症状的比较疗效和耐受性：一项基于剂量反应模型的网络meta分析

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-23 DOI: 10.1111/acps.70051

Itsuki Terao, Wakako Kodama

Background

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.

Methods

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.

Results

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.

Conclusions

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.

背景：抗精神病药物被广泛应用于包括阿尔茨海默病（AD）在内的痴呆患者的神经精神症状（nps），但平衡疗效和安全性仍然是一个主要的临床挑战。方法：通过CENTRAL、PubMed、CINAHL和ClinicalTrials.gov的综合文献检索，确定相关的随机对照试验。我们进行了一项基于剂量-反应模型的网络荟萃分析，以评估阿立哌唑、布雷克斯哌唑、利培酮、喹硫平和奥氮平在痴呆包括AD患者中不同剂量的NPS严重程度变化的疗效和因不良事件而停止治疗的耐受性。结果：纳入20项试验，共5844名受试者。除奥氮平在疗效方面呈钟形曲线外，大多数纳入的抗精神病药物在疗效和耐受性方面均表现出普遍的正剂量-反应关系。只有阿立哌唑10 mg、布雷克斯哌唑1 ~ 2.5 mg、利培酮1 ~ 2 mg、奥氮平2.5 ~ 5 mg显著优于安慰剂。与安慰剂相比，阿立哌唑10毫克、布雷哌唑3毫克、利培酮1毫克、奥氮平2.5毫克和15毫克、喹硫平200毫克的耐受性没有显著降低。此外，在某些剂量的几种抗精神病药物之间观察到疗效和耐受性的显着差异。结论：阿立哌唑10mg、brexpiprazole 1-2.5 mg、利培酮1mg、奥氮平2.5 mg均有效且耐受性良好，有可能成为较好的治疗方案。由于目前的模型包含了几个不确定性的来源，其研究结果应谨慎解释，并将其视为支持临床决策的临时框架。

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引用次数: 0

Clinician Assessed Rates of PTSD and Complex PTSD in a Medical-Rehabilitation Sample of Active-Duty Military Personnel in the Armed Forces of Ukraine 临床医生评估乌克兰武装部队现役军事人员医疗康复样本中创伤后应激障碍和复杂创伤后应激障碍的发生率。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-20 DOI: 10.1111/acps.70050

Philip Hyland, Mark Shevlin, Thanos Karatzias, Kristina Bondjers, Anna Scherbakova, Oksana Sulaieva, Anastasiia Bibikova, Olexandr Dudin, Anton Savchenko, Kseniia Voznitsyna, Victor Dosenko, Dmytro Martsenkovskyi

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

导读：自2014年俄罗斯入侵乌克兰以来，数百万人在乌克兰武装部队（AFU）服役，但目前还没有关于这一人群中创伤后应激障碍（PTSD）患病率的信息。本研究的主要目的是估计ICD-11创伤后应激障碍和复杂创伤后应激障碍（CPTSD）的发生率，以及在现役、战斗暴露的AFU军事人员样本中与严重抑郁症的合并症。方法：对乌克兰军队医院和康复中心招募的590名士兵进行临床访谈。他们都在军事行动中受到创伤。PTSD和CPTSD的诊断采用国际创伤访谈法，重度抑郁症的当前发作采用迷你国际神经精神病学访谈法。结果：总体而言，67.4%的士兵被诊断为ICD-11 PTSD或CPTSD，其中45.9%被诊断为PTSD， 21.5%被诊断为CPTSD。此外，34.4%的人被诊断为重度抑郁症，PTSD（45.0%）和CPTSD（51.2%）的合并症较高。目前吸烟者和酗酒者的PTSD发病率升高，而军官（与士兵相比）和从康复机构招募的人员（与综合医院相比）的CPTSD发病率升高。结论：虽然不能代表整个AFU人口，但这些结果表明，乌克兰成千上万的士兵（和退伍军人）可能正在经历与他们的战斗经历相关的临床显著创伤后应激。在寻找可扩展的方法来解决这一心理健康挑战的背景下讨论了结果。

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引用次数: 0

Clinical Judgment and the Architecture of Reasoning in Psychiatry 精神病学的临床判断和推理架构。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-20 DOI: 10.1111/acps.70047

Melvin G. McInnis, J. Raymond DePaulo

<p>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” [<span>1</span>]. Two decades later, Walter Pagel traced this lineage to the Greek concept of <i>physis</i>, the individual's self-regulating nature and capacity for recovery [<span>2</span>]. 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 <i>physis</i>, 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 [<span>2</span>].</p><p>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.</p><p>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.” [<span>3</span>] 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 [<span>4</span>], this loss is particularly acute.</p><p>The rise of categorical diagnostic systems, culminating in the <i>DSM</i> and <i>ICD</i>, transformed psychiatry into a science of reliability [<span>5</span>]. 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 [<span>6</span>]. 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.</p><p>Yet the very success of this approach exposed its limits. The rules that standardized diagno

纵观医学史，有一条原则始终不变：临床判断的智慧不可替代。从希波克拉底开始，理解疾病是如何在受苦的人的生命中展开的，是一个优先考虑的问题。1913年，法国临床医生阿纳托尔·肖法德（Anatole Chauffard）将预后描述为诊断与治疗之间的重要桥梁；他定义了医学的基本三位一体：“知道、预见、行动”。二十年后，沃尔特·佩格尔（Walter Pagel）将这种血统追溯到希腊的物理学概念，即个人的自我调节天性和恢复能力。医生的艺术在于洞察人的这种自然史，预见转折点。佩格尔警告说，随着医学向解剖学和分类的精确分析方向发展，解读个体身体的解释艺术，通过理解疾病的生存过程来“了解、预见和行动”的能力，有可能被一种系统的病变和因果模型方法所取代。这一警告在精神病学领域最具先见之明。当其他医学领域在病理学、遗传学和影像学的指导下，朝着越来越精确的个性化护理形式发展时，精神病学却在与其认知核心的侵蚀作斗争。在一个主观经验、现象学、意义和价值与（尚不为人知的）生物学交叉的学科中，用基于检查表的分类取代临床判断在方法上是有问题的，并且是对处于护理中心的人的道德贬低。在本期杂志中，法瓦和圭迪指出，临床判断“被视为一种直觉艺术，将被不断发展的技术和人工智能所取代。”现代医学通过生物学、测量和分类获得了无与伦比的分析能力，但往往是以理解单个人类为代价的。在精神病学中，意义和价值观形成并被生物学所塑造，这种缺失尤为严重。分类诊断系统的兴起，在DSM和ICD中达到顶峰，将精神病学转变为一门可靠性科学。通过实施定义，这些系统为医疗保健提供了标准，使流行病学研究和公共卫生规划成为可能。精神疾病被纳入全球疾病负担研究，并证明精神疾病在全球残疾生活年数中所占的比例不成比例。在这方面，操作标准使精神病学民主化：它们为决策者、保险公司和研究人员提供了一种量化需求的共同语言。这些都是可靠的分类系统的优点和目的。然而，正是这种方法的成功暴露了它的局限性。标准化诊断的规则往往限制了临床医生对个体进行推理的能力，而个体又常常觉得自己被贴上了标签，或被自己的疾病所定义。患者和医生都越来越关注简短临床就诊的机械性质，算法护理和电子模板已经取代了曾经定义治疗遭遇的解释性对话。临床判断、了解和预见bbb的智力空间已经缩小。Maj重新审视了临床判断在诊断和分类中的作用，他指出，DSM-5消除了对重度抑郁症的丧亲排除，迫使该领域面对基于规则的有效性和上下文理解之间的差异[10]。为了缓和将正常悲伤医学化的风险，手册引入了一个注释，承认区分抑郁症和对失去的正常反应“不可避免地需要临床判断”。对马杰来说，这既是一种让步，也是一个机会，它提醒我们，比例、意义和文化不能仅仅通过症状计数来体现。临床判断重要性的重新出现和认可与Feinstein将临床判断表述为一种“不依赖于对病因、机制或疾病名称的了解，而是依赖于对患者的了解”的临床推理相呼应。范斯坦坚持认为，临床医生的任务不仅仅是应用统计证据，还要将临床推理与个体环境的微妙之处结合起来。在内科医学中，病因通常是已知的，这种推理可以改进管理；在很少建立因果关系的精神病学中，临床推理是基础。尽管结果不确定，但临床判断提供了连贯性，并有助于叙述（预测）。法瓦和圭迪直接建立在范斯坦的临床计量学遗产之上。临床计量学是临床测量的科学，是一种结构化的方法，用于捕捉分类诊断所忽略的现象，即：这些因素使病人和医生都能理解一个人的病情。他们的模型通过健康态度和行为、心理健康、人格脆弱性、医源性因素、医疗共病和适应负荷（慢性应激bbb的累积生理负担）等领域丰富了评估。这些数据是通过一个过程组织起来的，即“宏观分析”，即确定优先级和假设的迭代推理。每次迭代都是一个“中转站”，在这里，患者和临床医生在继续之前会暂停，接触基础，并测试理解。其目的是创造一个随着时间和对话而发展的生动模型和叙事。精神病学推理与大多数医学推理在性质上有所不同。心脏病专家从病变到机制再到治疗。精神科医生从不确定性开始，从叙述、行为和主观经验中推断意义。第一次临床接触通常需要在诊断本身明确之前就安全性、环境和支持做出决定、判断。这些最初的实用判断包括患者是否可以留在家中，洞察力是否完整，家庭支持是否足够，以及比任何算法评分更有效地确定结果。这样的推理是结构化的，但解释性的，将移情和经验观察与溯因逻辑和道德辨别力相结合。全面的历史和表述的迈耶尔传统早在1990年就预见到了这种方法。后来，McHugh和Slavney在《精神病学展望》（The Perspectives of Psychiatry）一书中阐述了四个互补的框架：疾病（分类）、维度（特征）、行为或目的论（目标导向）和叙事（有意义）。他们的模式体现了本体论多元论：承认不同的解释系统共存，必须通过推理来整合。正是这种多元推理定义了精神病学在临床判断背后持久而独特的智慧。然而，临床判断并不是一种纯粹的认知练习，它有很大的风险和陷阱。它承载着价值，并在一定程度上受到社会结构的驱动。精神病学的每一个决定都涉及到一些规范性的假设，比如什么是疾病，什么是损害，什么是理想的结果，以及谁的利益应该优先考虑。这些价值观不仅受到科学的影响，还受到文化、经济和地缘政治的影响。从历史上看，正常和病理的标准随着社会规范而变化，从歇斯底里到同性恋，从忧郁症到创伤后应激障碍。这样的转变提醒我们，判断从来不是在真空中进行的。临床医生认为什么是“合理的风险”、“功能损害”或“适当的反应”取决于普遍的社会和机构期望。DSM本身既是一种分类系统，也是一种文化文献。认识到这些偶然性并不会削弱临床判断的重要性；它只是让它负起责任。它让引导推理的价值观变得透明。伦理判断与认知判断交织在一起：精神科医生不仅要权衡什么是真实的，还要权衡什么是正确的，以及每个决定中蕴含的尊严、自主和文化意义。因此，价值意识成为推理学科的一部分，防止无意识的偏见，同时保持关怀的慈悲目的。此外，价值多元化与社会经济和地缘政治现实相交叉。获得医疗服务、保险结构和政治优先事项决定了哪些选择被认为是可行的。在资源匮乏的环境中，判断通常包括稀缺的实用主义伦理：决定如何分配有限的时间或药物。在富裕的环境中，挑战可能是过度诊断、过度治疗和商业化。因此，临床推理和判断必须保持反思，意识到影响它的力量，并对其易犯错误保持谦虚。临床判断的优势在于其情境敏感性、整合异质信息的能力以及对人类意义的开放性。它能让临床医生发现统计模型无法做到的事情：对痛苦的道德分量、恢复力的模式、标志着康复的微妙变化的移情理解。它本身也是容易出错的。认知偏见、过度自信和情感影响往往会扭曲判断；文化假设可能使差异病态化。现在的任务是将两者结合起来：培养既基于经验又具有道德意识的反思性临床判断。因此，精神病学培训应包括推理和决策伦理方面的明确教育。认知偏见意识、文化形成和叙事能力不是外围技能，而是判断的核心组成部分。监督应该使推理可见，为什么会得出一个特定的推理，什么价值决定了它，哪些替代方案被认为是正确的。在其基础上，临床判断与本体论过程联系在一起，试图确定患者世界中存在什么以及这些元素如何相互关联。本体提供了一种形式结构，允许推理从观察到推理连贯地移动。在精神病学中，精神和身体、生物因果关系和有意义的联系相互交

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引用次数: 0

Association Between Metabolic Syndrome, Obesity, and Cognitive Performances in Individuals With Bipolar Disorders: Cross-Sectional and Longitudinal Analyses in the FACE-BD Cohort 双相情感障碍患者代谢综合征、肥胖和认知表现之间的关系：FACE-BD队列的横断面和纵向分析

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-20 DOI: 10.1111/acps.70048

I. Palimaru, B. Etain, M. Leboyer, Y. Dansou, P. Favre, S. Gard, V. Aubin, F. Bellivier, R. Belzeaux, P. Courtet, C. Dubertret, E. Haffen, A. Lefrere, P. M. Llorca, E. Olié, M. Polosan, L. Samalin, R. Schwan, the FondaMental Academic Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators, P. Roux, O. Godin

Introduction

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.

Methods

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 (n = 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.

Results

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.

Conclusions

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.

导读：代谢综合征（MetS）被认为与双相情感障碍（BD）的认知障碍有关；然而，研究受到小样本量或横断面设计的限制。我们的目的是评估一个大型BD患者队列中met与认知表现之间的横断面和纵向关联。方法：从FACE-BD队列中纳入1175名DSM-IV诊断为BD的个体，通过标准化的临床和神经心理学测试进行评估，并在2年后对一个子样本（n = 367）进行认知再测试。利用主成分分析法，建立了一个全局认知指数。利用多重协方差分析和纵向数据的线性混合模型来探讨met与基线认知表现之间的关系。结果：本组患者met患病率为21.5%。在横断面分析中，多变量分析确定了MetS与较差的认知表现之间的关联，独立于年龄、性别、教育水平、精神药物治疗和合并症。具体来说，met患者表现出较差的结果（整体认知指数、认知灵活性、抑制和言语记忆）。调整后，纵向分析显示，第2年全球认知指数没有变化，没有时间与代谢综合征的相互作用。结论：我们的研究结果表明，MetS与双相障碍患者较差的认知表现存在横断面相关性，而非纵向相关性。本研究强调了系统准确筛查双相障碍患者代谢异常以及筛查认知缺陷（尤其是MetS患者）的重要性。我们的研究结果表明，在随访期间，MetS不是认知能力下降的危险因素，但需要进一步的纵向研究。

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引用次数: 0

Resilience in Bipolar Disorder Compared to Clinical and Non-Clinical Populations: A Systematic Review and Meta-Analysis 与临床和非临床人群相比，双相情感障碍患者的恢复力：一项系统综述和荟萃分析。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-12 DOI: 10.1111/acps.70042

Derek Clougher, Michele De Prisco, Brisa Solé, Laura Montejo, Maria Serra-Navarro, Maria Florencia Forte, Patricia Camprodon-Boadas, Elena de la Serna, Vincenzo Oliva, Sara Martin-Parra, Jose Sánchez-Moreno, Benedikt L. Amann, Marina Garriga, Norma Verdolini, Marta Ribases, Kamilla Miskowiak, Anabel Martínez-Aran, Eduard Vieta, Silvia Amoretti, Carla Torrent

Introduction

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.

Method

PubMed/MEDLINE, PsycINFO, and Scopus were systematically searched from inception to August 8th, 2024.

Results

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, p < 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, p = 0.013). No significant differences were found between BD and major depressive disorder (MDD).

Conclusion

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.

临床和非临床人群中均存在适应力；然而，研究其在双相情感障碍（BD）中的作用的文献很少。本系统综述和荟萃分析的目的是证实现有的研究双相障碍患者恢复力的文献，并将其与临床和非临床人群进行比较。方法：系统检索自建校至2024年8月8日的PubMed/MEDLINE、PsycINFO、Scopus数据库。结果：28项研究采用有效的弹性量表，共纳入3094名双相障碍患者、4100名健康对照和1768名其他精神诊断患者，其中21项研究采用随机效应荟萃分析。结论：由于观察到的高度异质性和弹性的定义和测量方法上的挑战，研究结果应谨慎解释。未来的研究应旨在通过将其评估作为临床评估的标准化要素来更好地表征双相障碍的恢复能力。这将为减轻这种慢性疾病负担的战略提供基础。

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引用次数: 0

Correction to “Homocysteine Levels and Glucose Metabolism in Non-Obese, Non-Diabetic Chronic Schizophrenia” 更正“非肥胖、非糖尿病性慢性精神分裂症的同型半胱氨酸水平和葡萄糖代谢”。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-05 DOI: 10.1111/acps.70045

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,” Acta Psychiatrica Scandinavica 113 (2006): 121–125. https://doi.org/10.1111/j.1600-0447.2005.00621.x.

The author's name, A. E. Evins, has been corrected to A. E. Evins.

We apologize for this error.

D. C. Henderson， P. M. Copeland， D. D. Nguyen， C. P. Borba， C. Cather， A. Eden Evins， O. Freudenreich， L. Baer和D. C. Goff，“非肥胖、非糖尿病慢性精神分裂症的同型半胱氨酸水平和葡萄糖代谢”，《斯堪的纳维亚精神病学学报》113(2006):121-125。https://doi.org/10.1111/j.1600-0447.2005.00621.x.The作者姓名A. E. Evins已更正为A. E. Evins。我们为这个错误道歉。

引用次数: 0

Correction to “A Double-Blind, Placebo-Controlled Trial of Rosiglitazone for Clozapine-Induced Glucose Metabolism Impairment in Patients with Schizophrenia” 更正“罗格列酮治疗氯氮平诱导的精神分裂症患者糖代谢障碍的双盲、安慰剂对照试验”。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-11-03 DOI: 10.1111/acps.70044

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,” Acta Psychiatrica Scandinavica 119 (2009): 457–465. https://doi.org/10.1111/j.1600-0447.2008.01325.x.

The author's name, A. Eden Evins, has been corrected to A. E. Evins.

We apologize for this error.

D. C. Henderson， X. Fan， B. Sharma， P. M. Copeland， C. P. Borba， R. Boxill， O. Freudenreich， C. Cather， A. Eden Evins和D. C. Goff，“罗格列酮治疗氯氮平诱导的精神分裂症患者糖代谢障碍的双盲、安慰剂对照试验”，《精神病学杂志》119(2009):457-465。https://doi.org/10.1111/j.1600-0447.2008.01325.x.The作者A. Eden Evins已被更正为A. E. Evins。我们为这个错误道歉。

引用次数: 0