首页 > 最新文献

Acta Psychiatrica Scandinavica最新文献

英文 中文
Diagnostic and demographic factors of pediatric and adult catatonia hospitalizations: A 2016–2020 National Inpatient Sample Study 儿童和成人紧张症住院患者的诊断和人口统计因素:2016-2020年全国住院患者样本研究》。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-08-08 DOI: 10.1111/acps.13744
James Luccarelli, Mark Kalinich, Gregory Fricchione, Felicia Smith, Scott R. Beach, Joshua R. Smith

Objective

Catatonia is a neuropsychiatric disorder that can occur in patients of any age, but it is uncertain whether patient demographics or underlying diagnoses differ between pediatric and adult patients. This study investigates patients of all ages diagnosed with catatonia during acute care hospitalizations in the United States over a 5-year period.

Method

The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients with a discharge diagnosis of catatonia between 2016 and 2020 with patients stratified by age as pediatric (≤18 years) or adult (>18 years).

Results

Among 174,776,205 hospitalizations recorded in the NIS from 2016 to 2020, 61,990 (95% CI: 60,257 to 63,723; 0.035%) involved a diagnosis of catatonia. Of these, 3255 were for pediatric patients and 58,735 were for adult patients. Compared with adult patients, pediatric catatonia patients were more likely to be male and non-White. Diagnostically, psychotic disorders, encephalitis, and neurodevelopmental disorders were more common primary discharge diagnoses in pediatric patients, while adult patients more frequently were diagnosed with mood disorders. Length of stay was not significantly different between pediatric and adult catatonia hospitalizations. Physical restraints were commonly applied for patients with catatonia.

Conclusion

Pediatric and adult catatonia patients differed in sex, race, and diagnosis, although hospital length of stay was not different between pediatric and adult catatonia hospitalizations. These results may inform catatonia diagnosis in the hospital setting and point to disparities that could be targets of quality improvement efforts.

目的:紧张症是一种神经精神疾病,可发生在任何年龄段的患者身上,但尚不确定儿童患者和成人患者的人口统计学特征或潜在诊断是否存在差异。本研究调查了 5 年内在美国急诊住院期间被诊断为紧张症的各年龄段患者:方法:对全国住院患者样本(一个包含所有付费者的急症护理出院患者数据库)进行了查询,以了解 2016 年至 2020 年期间出院诊断为紧张症的患者的情况,并将患者按年龄分为儿科(≤18 岁)和成人(>18 岁):2016年至2020年,在国家统计研究所记录的174776205例住院病例中,61990例(95% CI:60257至63723;0.035%)涉及紧张症诊断。其中,3255 例为儿科患者,58735 例为成人患者。与成人患者相比,儿童紧张症患者更可能是男性和非白人。在诊断上,儿科患者出院时的主要诊断更常见的是精神障碍、脑炎和神经发育障碍,而成人患者则更多地被诊断为情绪障碍。儿童和成人紧张性精神障碍患者的住院时间没有明显差异。结论:儿童和成人紧张症患者的住院时间没有明显差异:结论:儿童和成人紧张症患者在性别、种族和诊断方面存在差异,但儿童和成人紧张症患者的住院时间并无不同。这些结果可为医院对紧张症的诊断提供参考,并指出了可作为质量改进目标的差异。
{"title":"Diagnostic and demographic factors of pediatric and adult catatonia hospitalizations: A 2016–2020 National Inpatient Sample Study","authors":"James Luccarelli,&nbsp;Mark Kalinich,&nbsp;Gregory Fricchione,&nbsp;Felicia Smith,&nbsp;Scott R. Beach,&nbsp;Joshua R. Smith","doi":"10.1111/acps.13744","DOIUrl":"10.1111/acps.13744","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Catatonia is a neuropsychiatric disorder that can occur in patients of any age, but it is uncertain whether patient demographics or underlying diagnoses differ between pediatric and adult patients. This study investigates patients of all ages diagnosed with catatonia during acute care hospitalizations in the United States over a 5-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients with a discharge diagnosis of catatonia between 2016 and 2020 with patients stratified by age as pediatric (≤18 years) or adult (&gt;18 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 174,776,205 hospitalizations recorded in the NIS from 2016 to 2020, 61,990 (95% CI: 60,257 to 63,723; 0.035%) involved a diagnosis of catatonia. Of these, 3255 were for pediatric patients and 58,735 were for adult patients. Compared with adult patients, pediatric catatonia patients were more likely to be male and non-White. Diagnostically, psychotic disorders, encephalitis, and neurodevelopmental disorders were more common primary discharge diagnoses in pediatric patients, while adult patients more frequently were diagnosed with mood disorders. Length of stay was not significantly different between pediatric and adult catatonia hospitalizations. Physical restraints were commonly applied for patients with catatonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pediatric and adult catatonia patients differed in sex, race, and diagnosis, although hospital length of stay was not different between pediatric and adult catatonia hospitalizations. These results may inform catatonia diagnosis in the hospital setting and point to disparities that could be targets of quality improvement efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"234-244"},"PeriodicalIF":5.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905105","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}
引用次数: 0
Monoamine oxidase inhibitors in depression treatment: Addressing gaps and future directions 抑郁症治疗中的单胺氧化酶抑制剂:弥补差距与未来方向。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-26 DOI: 10.1111/acps.13740
Jen-Chin Lee, Lien-Chung Wei
{"title":"Monoamine oxidase inhibitors in depression treatment: Addressing gaps and future directions","authors":"Jen-Chin Lee,&nbsp;Lien-Chung Wei","doi":"10.1111/acps.13740","DOIUrl":"10.1111/acps.13740","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"573-574"},"PeriodicalIF":5.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764572","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}
引用次数: 0
Digital nature: Unveiling the impact and safety of FlowVR group intervention for depression in a feasibility trial. 数字自然:在可行性试验中揭示 FlowVR 小组干预对抑郁症的影响和安全性。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-24 DOI: 10.1111/acps.13731
Franziska Miegel, Luzie Lohse, Lena Jelinek, Jakob Scheunemann, Tana Gabbert, Gesche Schauenburg, Lukas Bittner, Fariba Mostajeran, Simone Kühn, Jürgen Gallinat, Amir Yassari

Objective: This study addresses the limitations of existing interventions for depression, such as a deficit-oriented focus, overlooking the utilization of positive elements such as nature, and neglecting the incorporation of group effects. The present feasibility study examines FlowVR, a resource-oriented, nature-inspired virtual reality (VR)-based group therapy. Previously tested individually in a pilot study for non-clinical participants, FlowVR has demonstrated positive effects on depressive symptoms. This study assesses the impact and safety of FlowVR in a group setting within a clinical sample using a one-armed study design.

Method: Forty-two inpatients and day patients with depression were recruited. Before and after the FlowVR intervention period of 4 weeks (two sessions per week), depressive symptoms were assessed (Beck Depression Inventory-II; BDI). Symptomatology (i.e., depressive symptoms), depression-associated variables (i.e., self-efficacy), intervention-specific variables (feeling of flow), and VR-specific variables (simulator sickness) were assessed before and after each session.

Results: Linear mixed effect models showed that symptomatology (depression, negative affect, current anxiety), depression-associated constructs (self-efficacy, motivation), and intervention-specific variables (flow) improved over the course of the sessions. No variable deteriorated more in one session compared to any other session. The lasso regression identified five potential predictors for the change in depression (BDI-II), yet these could not be validated in a subsequent linear regression analysis.

Conclusion: To conclude, FlowVR had the hypothesized positive impact over the course of the sessions, showing, for example, improvements in symptomatology. The sessions have demonstrated safety with no notable deteriorations. Therefore, FlowVR is deemed safe for clinical patients and group settings. However, further research is needed to explore predictors for the change in depression.

研究目的本研究探讨了现有抑郁症干预措施的局限性,例如以缺陷为导向的关注点、忽视对自然等积极因素的利用以及忽视团体效应的融入。本可行性研究对 FlowVR 进行了研究,这是一种以资源为导向、以自然为灵感的虚拟现实(VR)团体疗法。此前,FlowVR 曾在一项针对非临床参与者的试点研究中进行过单独测试,结果表明它对抑郁症状有积极影响。本研究采用单臂研究设计,在临床样本中评估FlowVR在团体环境中的影响和安全性:方法:招募了 42 名抑郁症住院患者和日间患者。在为期 4 周的 FlowVR 干预期(每周两次)前后,对抑郁症状进行了评估(贝克抑郁量表-II;BDI)。在每次疗程前后对症状(即抑郁症状)、抑郁相关变量(即自我效能感)、干预特定变量(流动感)和 VR 特定变量(模拟器不适)进行了评估:线性混合效应模型显示,症状(抑郁、消极情绪、当前焦虑)、抑郁相关建构(自我效能、动机)和干预特定变量(流动感)在疗程中都有所改善。没有一个变量在某一疗程比其他疗程恶化得更严重。套索回归确定了抑郁变化(BDI-II)的五个潜在预测因素,但这些因素无法在随后的线性回归分析中得到验证:总之,FlowVR 在疗程中产生了假设的积极影响,例如症状得到改善。疗程表现出安全性,没有出现明显的恶化。因此,FlowVR 被认为对临床患者和小组环境是安全的。不过,还需要进一步研究抑郁症变化的预测因素。
{"title":"Digital nature: Unveiling the impact and safety of FlowVR group intervention for depression in a feasibility trial.","authors":"Franziska Miegel, Luzie Lohse, Lena Jelinek, Jakob Scheunemann, Tana Gabbert, Gesche Schauenburg, Lukas Bittner, Fariba Mostajeran, Simone Kühn, Jürgen Gallinat, Amir Yassari","doi":"10.1111/acps.13731","DOIUrl":"https://doi.org/10.1111/acps.13731","url":null,"abstract":"<p><strong>Objective: </strong>This study addresses the limitations of existing interventions for depression, such as a deficit-oriented focus, overlooking the utilization of positive elements such as nature, and neglecting the incorporation of group effects. The present feasibility study examines FlowVR, a resource-oriented, nature-inspired virtual reality (VR)-based group therapy. Previously tested individually in a pilot study for non-clinical participants, FlowVR has demonstrated positive effects on depressive symptoms. This study assesses the impact and safety of FlowVR in a group setting within a clinical sample using a one-armed study design.</p><p><strong>Method: </strong>Forty-two inpatients and day patients with depression were recruited. Before and after the FlowVR intervention period of 4 weeks (two sessions per week), depressive symptoms were assessed (Beck Depression Inventory-II; BDI). Symptomatology (i.e., depressive symptoms), depression-associated variables (i.e., self-efficacy), intervention-specific variables (feeling of flow), and VR-specific variables (simulator sickness) were assessed before and after each session.</p><p><strong>Results: </strong>Linear mixed effect models showed that symptomatology (depression, negative affect, current anxiety), depression-associated constructs (self-efficacy, motivation), and intervention-specific variables (flow) improved over the course of the sessions. No variable deteriorated more in one session compared to any other session. The lasso regression identified five potential predictors for the change in depression (BDI-II), yet these could not be validated in a subsequent linear regression analysis.</p><p><strong>Conclusion: </strong>To conclude, FlowVR had the hypothesized positive impact over the course of the sessions, showing, for example, improvements in symptomatology. The sessions have demonstrated safety with no notable deteriorations. Therefore, FlowVR is deemed safe for clinical patients and group settings. However, further research is needed to explore predictors for the change in depression.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755823","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}
引用次数: 0
Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis 胰高血糖素样肽激动剂用于控制抗精神病药物引起的体重增加:系统回顾和荟萃分析。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-24 DOI: 10.1111/acps.13734
Maarten Bak, Bea Campforts, Patrick Domen, Therese van Amelsvoort, Marjan Drukker

Introduction

Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG.

Materials and Methods

Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists.

Results

Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was −2.48 kg (95% Confidence Interval (CI) −5.12 to +0.64; p = 0.07), for liraglutide the mean weight loss was −4.70 kg (95% CI −4.85 to −4.56; p < 0.001). The mean change in BMI was −0.82 (95% CI −1.56 to −0.09; p = 0.03) in the exenatide groups and −1.52 (95% CI −1.83 to −1.22; p < 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea.

Conclusion

The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.

导言:控制抗精神病药物诱发体重增加(AIWG)患者的体重具有挑战性。除了生活方式干预外,药物干预也有助于减轻体重。本系统综述和荟萃分析评估了胰高血糖素样肽-1(GLP-1)激动剂对 AIWG 患者体重减轻的效果和不良反应:根据PRISMA指南,我们对盲法和开放标签的随机对照试验(RCT)、非随机对照试验和队列研究进行了荟萃分析,这些研究评估了GLP-1对AIWG患者的治疗效果,无论其是否患有精神疾病。检索了 PubMed、Embase、PsycINFO 和 Cochrane Library 等数据库。主要结果指标为体重和体重指数的变化。次要结果是 GLP-1 激动剂引起的不良反应和精神病理学严重程度的变化:结果:只纳入了艾塞那肽和利拉鲁肽的数据,即 5 项研究性临床试验和 1 项队列研究。艾塞那肽的平均体重减轻了-2.48千克(95% 置信区间(CI)-5.12至+0.64;P = 0.07),利拉鲁肽的平均体重减轻了-4.70千克(95% CI -4.85至-4.56;P 结论:GLP-1激动剂艾塞那肽和利拉鲁肽是诱导AIWG患者减轻体重的有效药物。其不良反应是可以接受的,而且添加 GLP-1 不会增加精神病理学的严重程度。然而,还需要进行更多的研究。
{"title":"Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis","authors":"Maarten Bak,&nbsp;Bea Campforts,&nbsp;Patrick Domen,&nbsp;Therese van Amelsvoort,&nbsp;Marjan Drukker","doi":"10.1111/acps.13734","DOIUrl":"10.1111/acps.13734","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was −2.48 kg (95% Confidence Interval (CI) −5.12 to +0.64; <i>p</i> = 0.07), for liraglutide the mean weight loss was −4.70 kg (95% CI −4.85 to −4.56; <i>p</i> &lt; 0.001). The mean change in BMI was −0.82 (95% CI −1.56 to −0.09; <i>p</i> = 0.03) in the exenatide groups and −1.52 (95% CI −1.83 to −1.22; <i>p</i> &lt; 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"516-529"},"PeriodicalIF":5.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755824","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}
引用次数: 0
A cross-dataset study on automatic detection of autism spectrum disorder from text data. 从文本数据中自动检测自闭症谱系障碍的跨数据集研究。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-20 DOI: 10.1111/acps.13737
Aleksander Wawer, Izabela Chojnicka, Justyna Sarzyńska-Wawer, Małgorzata Krawczyk

Objective: The goals of this article are as follows. First, to investigate the possibility of detecting autism spectrum disorder (ASD) from text data using the latest generation of machine learning tools. Second, to compare model performance on two datasets of transcribed statements, collected using two different diagnostic tools. Third, to investigate the feasibility of knowledge transfer between models trained on both datasets and check if data augmentation can help alleviate the problem of a small number of observations.

Method: We explore two techniques to detect ASD. The first one is based on fine-tuning HerBERT, a BERT-based, monolingual deep transformer neural network. The second one uses the newest, multipurpose text embeddings from OpenAI and a classifier. We apply the methods to two separate datasets of transcribed statements, collected using two different diagnostic tools: thought, language, and communication (TLC) and autism diagnosis observation schedule-2 (ADOS-2). We conducted several cross-dataset experiments in both a zero-shot setting and a setting where models are pretrained on one dataset and then training continues on another to test the possibility of knowledge transfer.

Results: Unlike previous studies, the models we tested obtained average results on ADOS-2 data but reached very good performance of the models in TLC. We did not observe any benefits from knowledge transfer between datasets. We observed relatively poor performance of models trained on augmented data and hypothesize that data augmentation by back translation obfuscates autism-specific signals.

Conclusion: The quality of machine learning models that detect ASD from text data is improving, but model results are dependent on the type of input data or diagnostic tool.

目标:本文的目标如下。首先,研究使用最新一代机器学习工具从文本数据中检测自闭症谱系障碍(ASD)的可能性。其次,比较使用两种不同诊断工具收集的两个语句转录数据集的模型性能。第三,研究在两个数据集上训练的模型之间进行知识转移的可行性,并检查数据扩增是否有助于缓解观测数据数量较少的问题:我们探索了两种检测 ASD 的技术。第一种技术基于对 HerBERT(一种基于 BERT 的单语深度变换器神经网络)的微调。第二种技术使用 OpenAI 最新的多用途文本嵌入和分类器。我们将这些方法应用于两个独立的语句转录数据集,这些数据集是使用两种不同的诊断工具收集的:思维、语言和交流(TLC)和自闭症诊断观察表-2(ADOS-2)。我们进行了多项跨数据集实验,既有零点测试,也有在一个数据集上对模型进行预训练,然后在另一个数据集上继续训练,以测试知识转移的可能性:与之前的研究不同,我们测试的模型在 ADOS-2 数据上的结果一般,但在 TLC 中的表现非常好。我们没有发现数据集之间的知识转移有任何好处。我们观察到在增强数据上训练的模型性能相对较差,并假设通过反向翻译增强数据会混淆自闭症的特异性信号:从文本数据中检测自闭症的机器学习模型的质量正在提高,但模型结果取决于输入数据或诊断工具的类型。
{"title":"A cross-dataset study on automatic detection of autism spectrum disorder from text data.","authors":"Aleksander Wawer, Izabela Chojnicka, Justyna Sarzyńska-Wawer, Małgorzata Krawczyk","doi":"10.1111/acps.13737","DOIUrl":"https://doi.org/10.1111/acps.13737","url":null,"abstract":"<p><strong>Objective: </strong>The goals of this article are as follows. First, to investigate the possibility of detecting autism spectrum disorder (ASD) from text data using the latest generation of machine learning tools. Second, to compare model performance on two datasets of transcribed statements, collected using two different diagnostic tools. Third, to investigate the feasibility of knowledge transfer between models trained on both datasets and check if data augmentation can help alleviate the problem of a small number of observations.</p><p><strong>Method: </strong>We explore two techniques to detect ASD. The first one is based on fine-tuning HerBERT, a BERT-based, monolingual deep transformer neural network. The second one uses the newest, multipurpose text embeddings from OpenAI and a classifier. We apply the methods to two separate datasets of transcribed statements, collected using two different diagnostic tools: thought, language, and communication (TLC) and autism diagnosis observation schedule-2 (ADOS-2). We conducted several cross-dataset experiments in both a zero-shot setting and a setting where models are pretrained on one dataset and then training continues on another to test the possibility of knowledge transfer.</p><p><strong>Results: </strong>Unlike previous studies, the models we tested obtained average results on ADOS-2 data but reached very good performance of the models in TLC. We did not observe any benefits from knowledge transfer between datasets. We observed relatively poor performance of models trained on augmented data and hypothesize that data augmentation by back translation obfuscates autism-specific signals.</p><p><strong>Conclusion: </strong>The quality of machine learning models that detect ASD from text data is improving, but model results are dependent on the type of input data or diagnostic tool.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730787","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}
引用次数: 0
Sex differences in self-harm and suicide in young autistic adults 自闭症青少年自残和自杀的性别差异。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-19 DOI: 10.1111/acps.13736
Laura Hull, Isidora Stark, Michael Lundberg, Viktor H. Ahlqvist, Selma Idring Nordström, Anna Ohlis, Gergö Hadlaczky, Dheeraj Rai, Cecilia Magnusson

Introduction

Both suicide and self-harm are disproportionately common in autistic people. Sex differences in risk of self-harm and suicide are observed in the general population, but findings are mixed for autistic people. Self-cutting may be a particularly risky self-harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self-harm in the association between self-harm and suicide in autistic and non-autistic adolescents and young adults.

Methods

We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self-harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self-harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self-harm and autism in females and males.

Results

We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non-autistic individuals (1,286,481 female; 1,341,901 male) aged 12–37 years. Incidence of suicide following self-harm was higher in autistic males (incidence per 100,000 risk-years = 169.0 [95% CI 135.1, 211.3]) than females (125.4 [99.4, 158.3]). The relative risk was higher for autistic females (HR 26.1 [95% CI 20.2, 33.7]) than autistic males (12.5 [9.9, 15.8]). An additive effect of both autism and self-harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self-harmed through cutting were at greatest risk of death from suicide (HR 25.1 [17.9, 35.2]), compared to other methods.

Conclusion

Autistic males and females are at increased risk of death from suicide following severe self-harm, particularly self-cutting.

导言:自杀和自残在自闭症患者中尤为常见。在一般人群中,自残和自杀的风险存在性别差异,但自闭症患者的情况则不尽相同。自切可能是自闭症患者自杀风险特别高的一种自残行为。我们旨在探讨自闭症青少年和非自闭症青少年中自残与自杀之间的性别差异和自残方式差异:我们使用了一份包含 280 万瑞典居民的总人口登记表。我们对参与者从 12 岁到 2021 年 12 月期间因自残而接受治疗以及因自杀而死亡的情况进行了跟踪调查。我们使用 Cox 比例危险回归模型计算自残后自杀死亡风险的危险比(HRs)和 95% 置信区间(CIs),并使用交互作用导致的相对过高风险(RERI)来探讨女性和男性自残与自闭症之间的交互作用:我们确定了 85,143 名自闭症患者(31,288 名女性;53,855 名男性)和 2,628,382 名非自闭症患者(1,286,481 名女性;1,341,901 名男性)的年龄在 12-37 岁之间。自闭症男性自残后自杀的发生率(每 100,000 风险年的发生率 = 169.0 [95% CI 135.1, 211.3])高于女性(125.4 [99.4, 158.3])。女性自闭症患者的相对风险(HR 26.1 [95% CI 20.2, 33.7])高于男性自闭症患者(12.5 [9.9, 15.8])。在女性(RERI = 9.8)和男性(2.0)中都观察到了自闭症和自我伤害的叠加效应。与其他方式相比,通过切割进行自我伤害的自闭症患者死于自杀的风险最大(HR 25.1 [17.9, 35.2]):结论:男性和女性自闭症患者在严重自残,尤其是自残后,死于自杀的风险会增加。
{"title":"Sex differences in self-harm and suicide in young autistic adults","authors":"Laura Hull,&nbsp;Isidora Stark,&nbsp;Michael Lundberg,&nbsp;Viktor H. Ahlqvist,&nbsp;Selma Idring Nordström,&nbsp;Anna Ohlis,&nbsp;Gergö Hadlaczky,&nbsp;Dheeraj Rai,&nbsp;Cecilia Magnusson","doi":"10.1111/acps.13736","DOIUrl":"10.1111/acps.13736","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Both suicide and self-harm are disproportionately common in autistic people. Sex differences in risk of self-harm and suicide are observed in the general population, but findings are mixed for autistic people. Self-cutting may be a particularly risky self-harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self-harm in the association between self-harm and suicide in autistic and non-autistic adolescents and young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self-harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self-harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self-harm and autism in females and males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non-autistic individuals (1,286,481 female; 1,341,901 male) aged 12–37 years. Incidence of suicide following self-harm was higher in autistic males (incidence per 100,000 risk-years = 169.0 [95% CI 135.1, 211.3]) than females (125.4 [99.4, 158.3]). The relative risk was higher for autistic females (HR 26.1 [95% CI 20.2, 33.7]) than autistic males (12.5 [9.9, 15.8]). An additive effect of both autism and self-harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self-harmed through cutting were at greatest risk of death from suicide (HR 25.1 [17.9, 35.2]), compared to other methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Autistic males and females are at increased risk of death from suicide following severe self-harm, particularly self-cutting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"223-233"},"PeriodicalIF":5.3,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730728","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}
引用次数: 0
Exploring actigraphy as a digital phenotyping measure: A study on differentiating psychomotor agitation and retardation in depression. 探索作为数字表型测量方法的行为记录仪:区分抑郁症患者精神运动性躁动和迟缓的研究。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-19 DOI: 10.1111/acps.13739
Julia Maruani, Sibylle Mauries, Feriel Zehani, Michel Lejoyeux, Pierre A Geoffroy

Introduction: Psychomotor activity stands out as a crucial symptom in characterizing behaviors associated with depression. This study aims to explore the potential of actigraphy as a tool for digital phenotyping in characterizing symptoms of psychomotor agitation and retardation, which are clinically challenging dimensions to capture, in patients diagnosed with major depressive episode (MDE) according to DSM-5 criteria.

Methods: We compared rest-activity circadian rhythm biomarkers measured by the Motion Watch 8 actigraphy between 58 (78.4%) patients with MDE and psychomotor retardation (PMR), and 16 (21.6%) patients with MDE and psychomotor agitation (PMA), according to DSM-5 criteria.

Results: Actigraphy allowed to objectively report PMA through heightened activity over a 24-h period, while PMR manifests as reduced activity during the most active 10 h. Lower rest-activity rhythm (RAR) amplitude in PMR was accompanied by increased irregularities in intra- and inter-day rhythms. Interestingly, actigraphy emerges as an objective tool to measure the characteristics of the active and rest periods, free from the confounding effects of sleep disturbances. Indeed, no differences in sleep disturbances were identified between patients exhibiting psychomotor agitation and those displaying PMR.

Conclusion: Digital phenotyping through actigraphy may aid in distinguishing psychomotor retardation and psychomotor agitation allowing for a more precise characterization of the depression phenotype. When integrated with clinical assessment, measurements from actigraphy could offer additional insights into activity rhythms alongside subjective assessments and hold the potential to augment existing clinical decision-making processes in psychiatry.

导言精神运动活动是描述抑郁症相关行为特征的一个重要症状。本研究旨在探索动觉仪作为数字表型工具在描述根据 DSM-5 标准诊断为重度抑郁发作(MDE)患者的精神运动性躁动和迟缓症状方面的潜力:根据DSM-5标准,我们比较了58例(78.4%)重度抑郁发作和精神运动迟滞(PMR)患者与16例(21.6%)重度抑郁发作和精神运动性躁动(PMA)患者使用Motion Watch 8动觉仪测量的休息-活动昼夜节律生物标记物:活动记录仪可通过 24 小时内的活动增加客观地报告 PMA,而 PMR 则表现为在最活跃的 10 小时内活动减少。PMR 的休息-活动节律(RAR)振幅较低,同时日内和日间节律的不规则性增加。有趣的是,活动记录仪是测量活动期和休息期特征的客观工具,不受睡眠干扰的影响。事实上,精神运动性躁动患者与 PMR 患者在睡眠障碍方面并无差异:结论:通过动图进行数字表型分析有助于区分精神运动迟滞和精神运动性躁动,从而更准确地描述抑郁症表型。当与临床评估相结合时,通过动作描记术进行的测量可在主观评估的基础上提供更多有关活动节律的见解,并有可能增强精神病学现有的临床决策过程。
{"title":"Exploring actigraphy as a digital phenotyping measure: A study on differentiating psychomotor agitation and retardation in depression.","authors":"Julia Maruani, Sibylle Mauries, Feriel Zehani, Michel Lejoyeux, Pierre A Geoffroy","doi":"10.1111/acps.13739","DOIUrl":"https://doi.org/10.1111/acps.13739","url":null,"abstract":"<p><strong>Introduction: </strong>Psychomotor activity stands out as a crucial symptom in characterizing behaviors associated with depression. This study aims to explore the potential of actigraphy as a tool for digital phenotyping in characterizing symptoms of psychomotor agitation and retardation, which are clinically challenging dimensions to capture, in patients diagnosed with major depressive episode (MDE) according to DSM-5 criteria.</p><p><strong>Methods: </strong>We compared rest-activity circadian rhythm biomarkers measured by the Motion Watch 8 actigraphy between 58 (78.4%) patients with MDE and psychomotor retardation (PMR), and 16 (21.6%) patients with MDE and psychomotor agitation (PMA), according to DSM-5 criteria.</p><p><strong>Results: </strong>Actigraphy allowed to objectively report PMA through heightened activity over a 24-h period, while PMR manifests as reduced activity during the most active 10 h. Lower rest-activity rhythm (RAR) amplitude in PMR was accompanied by increased irregularities in intra- and inter-day rhythms. Interestingly, actigraphy emerges as an objective tool to measure the characteristics of the active and rest periods, free from the confounding effects of sleep disturbances. Indeed, no differences in sleep disturbances were identified between patients exhibiting psychomotor agitation and those displaying PMR.</p><p><strong>Conclusion: </strong>Digital phenotyping through actigraphy may aid in distinguishing psychomotor retardation and psychomotor agitation allowing for a more precise characterization of the depression phenotype. When integrated with clinical assessment, measurements from actigraphy could offer additional insights into activity rhythms alongside subjective assessments and hold the potential to augment existing clinical decision-making processes in psychiatry.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730727","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}
引用次数: 0
Switching concerns: Bipolar disorder and the antidepressant dilemma 转换顾虑:躁郁症与抗抑郁药的两难选择。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-16 DOI: 10.1111/acps.13738
René Ernst Nielsen
<p>In a serene, picturesque town, there lived a devoted gardener named Lily. Known for her vibrant and diverse garden, Lily was cherished by her community for her meticulous care of her plants, which brought a splash of color and joy to everyone around. One summer, inspired by an article in a gardening magazine, Lily decided to experiment with a new type of fertilizer reputed to enhance the vibrancy and speed of her flowers' bloom. Initially, the results were spectacular—her garden transformed into an extraordinary display of vivid hues, earning widespread admiration from her neighbors. However, as days passed, an unexpected and troubling pattern emerged. Some plants grew uncontrollably, sprawling beyond their intended spaces, while others, previously healthy, began to wilt and die. Lily, distressed and bewildered, questioned whether the new fertilizer was to blame or if other factors, like the unusual summer weather, were at play.</p><p>This scenario mirrors the complexities faced in psychiatry when treating depressive episodes with antidepressants. Just as Lily's garden experienced unforeseen consequences, patients treated with antidepressants may experience shifts from euthymia to manic symptoms, potentially leading to a diagnostic transition from unipolar depression to bipolar disorder. In cases of bipolar disorder, the use of antidepressants potentially carries the risk of switching patients from depression through euthymia to hypomania or mania. The causal relationship between antidepressant treatment and these mood changes remains a topic of ongoing debate.<span><sup>1</sup></span> Clinicians often grapple with whether these changes are direct effects of the medication or if they reflect a natural progression and fluctuations of the mood disorder itself. Are antidepressants directly accountable, does the treatment more frequently result in euthymia and perhaps a greater risk of mania or are the antidepressant treatment not linked to switch of polarity? Tools like the Naranjo scale can help assess causality by evaluating the emergence of symptoms in relation to timing of treatment initiation, dose escalation, or recurrence after repeated administration, alongside side-effect symptom reduction following discontinuation or dose reduction.<span><sup>2</sup></span> Randomized controlled trials (RCTs) on antidepressants for unipolar depression show significant improvements in symptoms, particularly in severely affected patients.<span><sup>3, 4</sup></span> For bipolar disorder, RCTs have demonstrated the efficacy of treatments such as olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine on depressive symptoms during a depressive episode.<span><sup>5</sup></span> Given the DSM-5 classification of bipolar disorder into types I and II based on the occurrence of mania, treatment responses and primary end-point of treatment may vary accordingly, with a greater focus on depressive symptoms in bipol
在一个宁静、风景如画的小镇上,住着一位名叫莉莉的忠实园丁。莉莉的花园以生机勃勃、种类繁多而闻名,她精心照料自己的植物,为周围的每个人带来了一抹色彩和欢乐,因此深受社区居民的喜爱。有一年夏天,莉莉受到园艺杂志上一篇文章的启发,决定尝试使用一种新型肥料,据说这种肥料可以增强花朵的活力,加快花朵的绽放速度。起初,效果非常显著--她的花园变成了一个色彩鲜艳的非凡展示区,赢得了邻居们的广泛赞誉。然而,随着时间的推移,一个意想不到的令人不安的现象出现了。一些植物不受控制地生长,超出了它们原本的空间,而另一些原本健康的植物则开始枯萎死亡。莉莉既苦恼又困惑,她怀疑是否是新肥料的问题,或者是其他因素,比如不寻常的夏季天气。就像莉莉的花园经历了意想不到的后果一样,接受抗抑郁药物治疗的患者也可能经历从优郁状态到躁狂症状的转变,有可能导致从单相抑郁症到双相情感障碍的诊断转变。在双相情感障碍的病例中,抗抑郁药的使用有可能使患者从抑郁转为躁狂或轻度躁狂。抗抑郁剂治疗与这些情绪变化之间的因果关系仍然是一个争论不休的话题。1 临床医生经常会纠结于这些变化究竟是药物的直接作用,还是反映了情绪障碍本身的自然发展和波动。抗抑郁药是否应直接负责,治疗是否会更频繁地导致优郁状态,或许会增加躁狂症的风险,或者抗抑郁药治疗是否与极性转换无关?纳兰霍量表(Naranjo scale)等工具可以帮助评估因果关系,方法是评估症状的出现与开始治疗的时间、剂量增加或重复用药后的复发之间的关系,以及停药或减量后副作用症状的减轻情况。针对单相抑郁症的抗抑郁剂随机对照试验(RCT)显示,症状得到了显著改善,尤其是在病情严重的患者中。3, 4 针对双相情感障碍,RCT 证实了奥氮平加氟西汀、喹硫平、奥氮平、鲁拉西酮、鲁拉培酮、卡哌嗪和拉莫三嗪等治疗方法对抑郁发作期间抑郁症状的疗效。5 鉴于 DSM-5 根据躁狂的发生情况将双相情感障碍分为 I 型和 II 型,治疗反应和治疗的主要终点可能会相应不同,II 型双相情感障碍患者更侧重于抑郁症状,而 I 型双相情感障碍患者则更侧重于尽量减少抑郁症状和避免躁狂发作、7 对双相情感障碍患者进行的长期抗抑郁治疗也显示,抑郁反复发作的风险降低,而躁狂或躁狂症发作率却没有明显增加,其中又以双相情感障碍II期的数据最为可靠。9 因此,尽管使用抗抑郁剂治疗仍然是一种选择,但由于有更多和更长期的数据支持其疗效,指南通常建议首先使用其他治疗方法。此外,相当多的患者,尤其是那些没有出现、没有被问及或受到躁狂发作负面影响的双相情感障碍 II 患者,常常被误诊为重度抑郁障碍,导致诊断上的严重延误。12 因此,鉴于抗抑郁药是单相抑郁障碍患者的首选药物治疗,许多最终被诊断为双相情感障碍的患者在被诊断为双相情感障碍之前就已经接触过抗抑郁药,因此可以了解这些治疗方法的疗效和耐受性,以及相关的转换风险。
{"title":"Switching concerns: Bipolar disorder and the antidepressant dilemma","authors":"René Ernst Nielsen","doi":"10.1111/acps.13738","DOIUrl":"10.1111/acps.13738","url":null,"abstract":"&lt;p&gt;In a serene, picturesque town, there lived a devoted gardener named Lily. Known for her vibrant and diverse garden, Lily was cherished by her community for her meticulous care of her plants, which brought a splash of color and joy to everyone around. One summer, inspired by an article in a gardening magazine, Lily decided to experiment with a new type of fertilizer reputed to enhance the vibrancy and speed of her flowers' bloom. Initially, the results were spectacular—her garden transformed into an extraordinary display of vivid hues, earning widespread admiration from her neighbors. However, as days passed, an unexpected and troubling pattern emerged. Some plants grew uncontrollably, sprawling beyond their intended spaces, while others, previously healthy, began to wilt and die. Lily, distressed and bewildered, questioned whether the new fertilizer was to blame or if other factors, like the unusual summer weather, were at play.&lt;/p&gt;&lt;p&gt;This scenario mirrors the complexities faced in psychiatry when treating depressive episodes with antidepressants. Just as Lily's garden experienced unforeseen consequences, patients treated with antidepressants may experience shifts from euthymia to manic symptoms, potentially leading to a diagnostic transition from unipolar depression to bipolar disorder. In cases of bipolar disorder, the use of antidepressants potentially carries the risk of switching patients from depression through euthymia to hypomania or mania. The causal relationship between antidepressant treatment and these mood changes remains a topic of ongoing debate.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Clinicians often grapple with whether these changes are direct effects of the medication or if they reflect a natural progression and fluctuations of the mood disorder itself. Are antidepressants directly accountable, does the treatment more frequently result in euthymia and perhaps a greater risk of mania or are the antidepressant treatment not linked to switch of polarity? Tools like the Naranjo scale can help assess causality by evaluating the emergence of symptoms in relation to timing of treatment initiation, dose escalation, or recurrence after repeated administration, alongside side-effect symptom reduction following discontinuation or dose reduction.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Randomized controlled trials (RCTs) on antidepressants for unipolar depression show significant improvements in symptoms, particularly in severely affected patients.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; For bipolar disorder, RCTs have demonstrated the efficacy of treatments such as olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine on depressive symptoms during a depressive episode.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Given the DSM-5 classification of bipolar disorder into types I and II based on the occurrence of mania, treatment responses and primary end-point of treatment may vary accordingly, with a greater focus on depressive symptoms in bipol","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"123-125"},"PeriodicalIF":5.3,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141618654","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}
引用次数: 0
A target trial emulation comparing the antidepressant effectiveness of selective serotonin reuptake inhibitors (SSRIs) highlighting the importance of patent-related confounding by indication 比较选择性 5-羟色胺再摄取抑制剂(SSRIs)的抗抑郁效果的目标试验模拟,突出了与专利相关的适应症混杂的重要性。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-12 DOI: 10.1111/acps.13729
Christopher Rohde, Fredrik Hieronymus, Søren Dinesen Østergaard
<div> <section> <h3> Background</h3> <p>The comparative effectiveness of selective serotonin reuptake inhibitors (SSRIs) has been subjected to relatively little research. However, a recent study based on target trial emulation suggested that sertraline may be more effective than escitalopram.</p> </section> <section> <h3> Aims</h3> <p>To investigate whether sertraline, citalopram, and escitalopram differ in their effectiveness—assessed via the risk of psychiatric hospital admission and suicide following treatment initiation. The choice to focus on sertraline, citalopram, and escitalopram was made to limit confounding by indication, as the Danish depression treatment guideline from 2007 specifically listed these three SSRIs as first choice.</p> </section> <section> <h3> Method</h3> <p>We conducted a target trial emulation based on data from Danish registers. We identified all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram in the period from January 1, 2007, to March 1, 2019. These individuals were followed until psychiatric hospital admission or suicide (separate analyses), death, 1 year after treatment initiation or end of data. Cox proportional hazards regression adjusted for relevant baseline covariates was performed to emulate randomized treatment allocation, comparing the rate of psychiatric hospital admission and suicide for individuals treated with sertraline (used as reference), citalopram or escitalopram, respectively. For escitalopram, we conducted a sensitivity analysis excluding data from the period during which the drug was sold under patent, as the price of the drug during that time likely entailed a different prescription pattern, increasing the risk of (“patent-related”) confounding by indication.</p> </section> <section> <h3> Results</h3> <p>We identified 56,865, 118,145, and 31,083 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. Using sertraline as reference, the adjusted hazard rate ratio (aHRR) for psychiatric admission was 0.98 (95% CI = 0.91–1.05) for citalopram and 1.21 (95% CI = 1.10–1.32) for escitalopram. Notably, in the sensitivity analysis only including patients initiating treatment after the escitalopram patent had expired, the increased risk of psychiatric hospital admission associated with escitalopram treatment was no longer present (aHRR = 0.98, 95% CI = 0.82–1.18). The results of the analyses of suicide were inconclusive, due to few outcome events.</p> </section> <section>
背景:关于选择性血清素再摄取抑制剂(SSRIs)疗效比较的研究相对较少。目的:研究舍曲林、西酞普兰和艾司西酞普兰的疗效是否存在差异--通过开始治疗后入住精神病院和自杀的风险进行评估。选择舍曲林、西酞普兰和艾司西酞普兰作为研究对象是为了限制适应症带来的干扰,因为2007年的丹麦抑郁症治疗指南明确将这三种SSRIs列为首选药物:我们根据丹麦登记册中的数据进行了目标试验模拟。我们确定了 2007 年 1 月 1 日至 2019 年 3 月 1 日期间开始接受舍曲林、西酞普兰或艾司西酞普兰治疗的所有抑郁症患者。我们对这些患者进行了随访,直至他们入院或自杀(单独分析)、死亡、开始治疗 1 年后或数据结束。为模拟随机治疗分配,我们进行了调整相关基线协变量的 Cox 比例危险度回归,比较了分别接受舍曲林(作为参照)、西酞普兰或艾司西酞普兰治疗的患者的精神病院入院率和自杀率。对于艾司西酞普兰,我们进行了一项敏感性分析,排除了该药在专利期内销售的数据,因为该药在专利期内的价格可能导致不同的处方模式,从而增加了("专利相关")适应症混杂的风险:我们分别确定了56865人、118145人和31083人开始使用舍曲林、西酞普兰和艾司西酞普兰进行治疗。以舍曲林为参照,西酞普兰和艾司西酞普兰的精神病入院调整危险率比(aHRR)分别为0.98(95% CI = 0.91-1.05)和1.21(95% CI = 1.10-1.32)。值得注意的是,在仅包括艾司西酞普兰专利到期后开始治疗的患者的敏感性分析中,与艾司西酞普兰治疗相关的精神病入院风险增加不再存在(aHRR = 0.98,95% CI = 0.82-1.18)。由于结果事件较少,自杀分析结果尚无定论:结论:舍曲林、西酞普兰和艾司西酞普兰在治疗抑郁症方面似乎没有不同的疗效。对于药物流行病学研究(包括那些采用目标试验模拟的研究)而言,考虑到潜在的专利相关、时间变化、适应症混杂(通过严重程度)是至关重要的。
{"title":"A target trial emulation comparing the antidepressant effectiveness of selective serotonin reuptake inhibitors (SSRIs) highlighting the importance of patent-related confounding by indication","authors":"Christopher Rohde,&nbsp;Fredrik Hieronymus,&nbsp;Søren Dinesen Østergaard","doi":"10.1111/acps.13729","DOIUrl":"10.1111/acps.13729","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The comparative effectiveness of selective serotonin reuptake inhibitors (SSRIs) has been subjected to relatively little research. However, a recent study based on target trial emulation suggested that sertraline may be more effective than escitalopram.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To investigate whether sertraline, citalopram, and escitalopram differ in their effectiveness—assessed via the risk of psychiatric hospital admission and suicide following treatment initiation. The choice to focus on sertraline, citalopram, and escitalopram was made to limit confounding by indication, as the Danish depression treatment guideline from 2007 specifically listed these three SSRIs as first choice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a target trial emulation based on data from Danish registers. We identified all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram in the period from January 1, 2007, to March 1, 2019. These individuals were followed until psychiatric hospital admission or suicide (separate analyses), death, 1 year after treatment initiation or end of data. Cox proportional hazards regression adjusted for relevant baseline covariates was performed to emulate randomized treatment allocation, comparing the rate of psychiatric hospital admission and suicide for individuals treated with sertraline (used as reference), citalopram or escitalopram, respectively. For escitalopram, we conducted a sensitivity analysis excluding data from the period during which the drug was sold under patent, as the price of the drug during that time likely entailed a different prescription pattern, increasing the risk of (“patent-related”) confounding by indication.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 56,865, 118,145, and 31,083 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. Using sertraline as reference, the adjusted hazard rate ratio (aHRR) for psychiatric admission was 0.98 (95% CI = 0.91–1.05) for citalopram and 1.21 (95% CI = 1.10–1.32) for escitalopram. Notably, in the sensitivity analysis only including patients initiating treatment after the escitalopram patent had expired, the increased risk of psychiatric hospital admission associated with escitalopram treatment was no longer present (aHRR = 0.98, 95% CI = 0.82–1.18). The results of the analyses of suicide were inconclusive, due to few outcome events.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 ","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"198-208"},"PeriodicalIF":5.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13729","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141588996","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}
引用次数: 0
Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis 单胺氧化酶抑制剂治疗情绪障碍抑郁发作的疗效和耐受性:系统综述和网络荟萃分析。
IF 5.3 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-07-12 DOI: 10.1111/acps.13728
Anna Giménez-Palomo, Anjli K. Chamdal, Natalie Gottlieb, Mojtaba Lotfaliany, Tahir Jokinen, Eslam M. Bastawy, Katherine Adlington, Nawal Benachar, Seetal Dodd, Isabella Pacchiarotti, Eduard Vieta, Michael Berk, Paul R. A. Stokes

Background

Monoamine oxidase inhibitors (MAOIs) are considered third-line treatments for treatment resistant depression; however, they are underused in clinical practice.

Aims

This study aimed to assess the efficacy, tolerability, and acceptability of MAOIs for the treatment of depression in comparison with other antidepressant treatments.

Methods

A systematic review and network meta-analysis of randomised clinical trials was performed to compare the efficacy, tolerability and acceptability between MAOIs and other antidepressant treatments for the treatment of depressive episodes.

Results

A total of 83 double-blinded, randomised controlled trials were included in the analysis, with 7765 participants assigned to an active treatment and 1844 assigned to placebo. Several MAOIs, including isocarboxazid, phenelzine, tranylcypromine and moclobemide, showed significantly higher efficacy compared with placebo. The tolerability and acceptability of MAOIs was comparable to other antidepressants.

Limitations

A disproportionate number of studies investigating the most commonly used MAOIs, such as moclobemide and phenelzine, and a lack of specific studies focusing on treatment-resistant and atypical depression.

Conclusions

MAOIs are similar in efficacy to other antidepressants for the treatment of depression. However, more studies are needed comparing MAOI treatment in people with treatment-resistant, atypical and bipolar depression.

背景:单胺氧化酶抑制剂(MAOIs)被认为是治疗耐药抑郁症的三线疗法,但在临床实践中却未得到充分使用:方法:对随机临床试验进行系统回顾和网络荟萃分析,比较MAOIs与其他抗抑郁药物治疗抑郁发作的疗效、耐受性和可接受性:共有 83 项双盲随机对照试验被纳入分析范围,其中 7765 人被分配接受了积极治疗,1844 人被分配接受了安慰剂治疗。与安慰剂相比,包括异恶唑、苯乙肼、氨甲环丙胺和吗氯贝胺在内的几种 MAOIs 的疗效显著更高。MAOIs的耐受性和可接受性与其他抗抑郁药相当:对最常用的 MAOIs(如吗氯贝胺和苯乙肼)进行调查的研究数量过多,缺乏针对耐药性抑郁症和非典型抑郁症的具体研究:结论:在治疗抑郁症方面,MAOIs 的疗效与其他抗抑郁药相似。结论:MAOIs 治疗抑郁症的疗效与其他抗抑郁药相似,但需要更多的研究来比较 MAOI 治疗耐药抑郁症、非典型抑郁症和双相抑郁症患者的疗效。
{"title":"Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis","authors":"Anna Giménez-Palomo,&nbsp;Anjli K. Chamdal,&nbsp;Natalie Gottlieb,&nbsp;Mojtaba Lotfaliany,&nbsp;Tahir Jokinen,&nbsp;Eslam M. Bastawy,&nbsp;Katherine Adlington,&nbsp;Nawal Benachar,&nbsp;Seetal Dodd,&nbsp;Isabella Pacchiarotti,&nbsp;Eduard Vieta,&nbsp;Michael Berk,&nbsp;Paul R. A. Stokes","doi":"10.1111/acps.13728","DOIUrl":"10.1111/acps.13728","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Monoamine oxidase inhibitors (MAOIs) are considered third-line treatments for treatment resistant depression; however, they are underused in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to assess the efficacy, tolerability, and acceptability of MAOIs for the treatment of depression in comparison with other antidepressant treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and network meta-analysis of randomised clinical trials was performed to compare the efficacy, tolerability and acceptability between MAOIs and other antidepressant treatments for the treatment of depressive episodes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 83 double-blinded, randomised controlled trials were included in the analysis, with 7765 participants assigned to an active treatment and 1844 assigned to placebo. Several MAOIs, including isocarboxazid, phenelzine, tranylcypromine and moclobemide, showed significantly higher efficacy compared with placebo. The tolerability and acceptability of MAOIs was comparable to other antidepressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Limitations</h3>\u0000 \u0000 <p>A disproportionate number of studies investigating the most commonly used MAOIs, such as moclobemide and phenelzine, and a lack of specific studies focusing on treatment-resistant and atypical depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MAOIs are similar in efficacy to other antidepressants for the treatment of depression. However, more studies are needed comparing MAOI treatment in people with treatment-resistant, atypical and bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"500-515"},"PeriodicalIF":5.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141597954","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}
引用次数: 0
期刊
Acta Psychiatrica Scandinavica
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1