Pedro Sonim, Rui M. Ferreira, Inês Lourenço, Lia Fernandes, Ana Rita Ferreira
Introduction
The use of off-label, low doses of second-generation antipsychotics (SGAs), in particular quetiapine, has risen significantly. SGAs are known to cause metabolic adverse effects, including weight gain. The aim of this systematic review and meta-analysis was to assess the impact of low-dose quetiapine on metabolic outcomes, such as weight, glycemic, and lipid metabolism.
Methods
Following the PRISMA statement, PubMed, Web of Science Core Collection, Cochrane Library, ClinicalTrials.gov, Google Scholar, and PsycINFO were systematically searched for randomized controlled trials > 4 weeks, reporting metabolic outcomes of quetiapine < 200 mg. RoB2 was used to assess bias. SPSS was used for quantitative data management and aggregation.
Results
Eight unique studies (n = 3085) were included, six of which were included in the meta-analysis. Low doses of quetiapine led to significant weight gain (mean difference [MD] = 0.58 kg, 95% CI: 0.32–0.83) and HDL cholesterol reduction (MD = −1.25 mg/dL, 95% CI: −1.86 to −0.65). Patients gaining ≥ 7% of baseline weight was 2.12 times more likely to have taken quetiapine.
Conclusion
Despite limited generalizability, these findings suggest that, even at low doses, quetiapine has an impact on metabolism. Further research is needed to clarify its role in metabolic dysregulation. This study was registered in the international database of prospectively registered systematic reviews (PROSPERO CRD420250588527).
{"title":"Metabolic Adverse Effects of Low-Dose Quetiapine: A Systematic Review and Meta-Analysis","authors":"Pedro Sonim, Rui M. Ferreira, Inês Lourenço, Lia Fernandes, Ana Rita Ferreira","doi":"10.1111/acps.70023","DOIUrl":"10.1111/acps.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The use of off-label, low doses of second-generation antipsychotics (SGAs), in particular quetiapine, has risen significantly. SGAs are known to cause metabolic adverse effects, including weight gain. The aim of this systematic review and meta-analysis was to assess the impact of low-dose quetiapine on metabolic outcomes, such as weight, glycemic, and lipid metabolism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the PRISMA statement, PubMed, Web of Science Core Collection, Cochrane Library, ClinicalTrials.gov, Google Scholar, and PsycINFO were systematically searched for randomized controlled trials > 4 weeks, reporting metabolic outcomes of quetiapine < 200 mg. RoB2 was used to assess bias. SPSS was used for quantitative data management and aggregation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight unique studies (<i>n</i> = 3085) were included, six of which were included in the meta-analysis. Low doses of quetiapine led to significant weight gain (mean difference [MD] = 0.58 kg, 95% CI: 0.32–0.83) and HDL cholesterol reduction (MD = −1.25 mg/dL, 95% CI: −1.86 to −0.65). Patients gaining ≥ 7% of baseline weight was 2.12 times more likely to have taken quetiapine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite limited generalizability, these findings suggest that, even at low doses, quetiapine has an impact on metabolism. Further research is needed to clarify its role in metabolic dysregulation. This study was registered in the international database of prospectively registered systematic reviews (PROSPERO CRD420250588527).</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"328-340"},"PeriodicalIF":5.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793018","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}
<p>We dedicate this editorial to Max Fink, MD, who died on June 15, 2025 at 102. Max was a paragon of psychiatry, an astute practitioner and researcher, prolific writer, fierce polemist, and advocate for electroconvulsive therapy (ECT), and generous mentor to younger colleagues, including both of us. Max was the strongest advocate for catatonia as an independent syndrome across many disorders and conditions, and inspired the making of The Catatonia Foundation, https://www.thecatatoniafoundation.org, a new organization established in 2022 by a parent in the aftermath of her daughter's significantly delayed catatonia diagnosis and lifesaving course of ECT in order to bring sorely needed awareness about catatonia and connect patients and families globally with treatment providers.</p><p>Max made several contributions to <i>Acta Psychiatrica Scandinavica</i>, including the 1996 papers [<span>1, 2</span>] establishing the Bush Francis Catatonia Rating Scale (BFCRS) and Bush Francis Catatonia Screening Instrument (BFCSI) as standards worldwide and promoting benzodiazepines (BZDs) and ECT as their primary treatments.</p><p>Almost 30 years later, Luccarelli et al. [<span>3</span>] have distilled a list of 4 catatonic symptoms (excitement, mutism, staring, and posturing) from the original 14-item BFCSI. The presence of only one of those four symptoms assures 97% sensitivity compared to the BFCSI. This makes the new screening instrument, coined the Catatonia Quick Screen (CQS) a perfect tool to improve recognition, diagnosis, and treatment of catatonia.</p><p>Catatonia has a storied history. Catatonia was likely first formally described in 16th century England by Phillip Barrough who wrote <i>Of congelation or taking</i> and mostly aptly commented upon the “lethargic” and “frenetic” poles of a disorder now recognized to often be characterized by both psychomotor agitation and retardation [<span>4</span>]. King Henry VI may have suffered from catatonia, with historians noting that he was unable to speak, walk or hold up his head after being informed of a military loss in Gascony in 1453, furthermore described as “smitten with a frenzy and his wit and reason withdrawn.” Catatonia may also have been present since the early days of humankind, with the potential for catatonia underscored in Lot's Wife, the Prophet Ezekiel and the unfortunate individuals who gazed upon Medusa and turned into stone [<span>5</span>]. Vagal intimations and the role of the fight, flight or freeze response in evolution further suggests that catatonia may be an intimate part of the human experience [<span>6</span>] and opens up new vistas on the role of psychological, traumatic, environmental, and social risk factors in catatonia [<span>7</span>].</p><p>The formal term catatonia was coined in 1874 by Kahlbaum [<span>8</span>] as a novel clinical entity with distinct motor, vocal, and behavioral symptoms that he observed in the Reimer Sanitarium in Gorlitz, then part of the Kingdom of
{"title":"How to Quickly Diagnose Catatonia, and a Farewell Salute to Max Fink, MD","authors":"Dirk Dhossche, Lee Elizabeth Wachtel","doi":"10.1111/acps.70024","DOIUrl":"10.1111/acps.70024","url":null,"abstract":"<p>We dedicate this editorial to Max Fink, MD, who died on June 15, 2025 at 102. Max was a paragon of psychiatry, an astute practitioner and researcher, prolific writer, fierce polemist, and advocate for electroconvulsive therapy (ECT), and generous mentor to younger colleagues, including both of us. Max was the strongest advocate for catatonia as an independent syndrome across many disorders and conditions, and inspired the making of The Catatonia Foundation, https://www.thecatatoniafoundation.org, a new organization established in 2022 by a parent in the aftermath of her daughter's significantly delayed catatonia diagnosis and lifesaving course of ECT in order to bring sorely needed awareness about catatonia and connect patients and families globally with treatment providers.</p><p>Max made several contributions to <i>Acta Psychiatrica Scandinavica</i>, including the 1996 papers [<span>1, 2</span>] establishing the Bush Francis Catatonia Rating Scale (BFCRS) and Bush Francis Catatonia Screening Instrument (BFCSI) as standards worldwide and promoting benzodiazepines (BZDs) and ECT as their primary treatments.</p><p>Almost 30 years later, Luccarelli et al. [<span>3</span>] have distilled a list of 4 catatonic symptoms (excitement, mutism, staring, and posturing) from the original 14-item BFCSI. The presence of only one of those four symptoms assures 97% sensitivity compared to the BFCSI. This makes the new screening instrument, coined the Catatonia Quick Screen (CQS) a perfect tool to improve recognition, diagnosis, and treatment of catatonia.</p><p>Catatonia has a storied history. Catatonia was likely first formally described in 16th century England by Phillip Barrough who wrote <i>Of congelation or taking</i> and mostly aptly commented upon the “lethargic” and “frenetic” poles of a disorder now recognized to often be characterized by both psychomotor agitation and retardation [<span>4</span>]. King Henry VI may have suffered from catatonia, with historians noting that he was unable to speak, walk or hold up his head after being informed of a military loss in Gascony in 1453, furthermore described as “smitten with a frenzy and his wit and reason withdrawn.” Catatonia may also have been present since the early days of humankind, with the potential for catatonia underscored in Lot's Wife, the Prophet Ezekiel and the unfortunate individuals who gazed upon Medusa and turned into stone [<span>5</span>]. Vagal intimations and the role of the fight, flight or freeze response in evolution further suggests that catatonia may be an intimate part of the human experience [<span>6</span>] and opens up new vistas on the role of psychological, traumatic, environmental, and social risk factors in catatonia [<span>7</span>].</p><p>The formal term catatonia was coined in 1874 by Kahlbaum [<span>8</span>] as a novel clinical entity with distinct motor, vocal, and behavioral symptoms that he observed in the Reimer Sanitarium in Gorlitz, then part of the Kingdom of ","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"325-327"},"PeriodicalIF":5.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797613","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}
<p>When I proposed the hypothesis that generative artificial intelligence chatbots (chatbots hereafter) might trigger delusions in individuals prone to psychosis in August 2023 [<span>1</span>], I was venturing into unknown territory. Indeed, in the virtual absence of evidence, the editorial was merely based on guesswork—stemming from my own use of these chatbots and my interest in the mechanisms underlying and driving delusions.</p><p>Following publication of the editorial, my charting of the territory slowly began as I started to receive the occasional email from chatbot users, their worried family members, and journalists. Most of these emails described situations where users' interactions with chatbots seemed to spark or bolster delusional ideation. The stories differed with regard to the specific topic at hand but were yet very similar: Consistently, the chatbots seemed to interact with the users in ways that aligned with, or intensified, prior unusual ideas or false beliefs—leading the users further out on these tangents, not rarely resulting in what, based on the descriptions, seemed to be outright delusions.</p><p>Over the past couple of months, I have noticed that the number of emails I have received on this topic from near and far has only increased. I have been working with psychiatric research for more than 15 years and can say, without a doubt, that none of my prior publications have led to this level of direct engagement with the public. Coinciding completely with the increase in the number of correspondences, the number of views of my 2023 editorial suddenly spiked dramatically, rising from a very modest plateau around 100 per month to approximately 750 views in May 2025 and 1375 views in June 2025.</p><p>The time trend described above has been paralleled by media coverage of the topic. Indeed, the New York Times [<span>2</span>], Rolling Stone [<span>3</span>], and many other outlets have published articles based on interviews and accounts from online fora [<span>4</span>] that are all compatible with people experiencing onset or worsening of delusions during intense and typically long interactions with chatbots (that do not grow tired of chatting) [<span>2</span>].</p><p>The timing of this spike in the focus on potential chatbot-fuelled delusions is likely not random as it coincided with the April 25th 2025 update to the GPT-4o model—a recent version of the popular ChatGPT chatbot from OpenAI [<span>5-7</span>]. This model has been accused of being overly “sycophantic” (insincerely affirming and flattering) toward users, caused by the model training leaning too hard on user preferences communicated via thumbs-up/thumbs-down assessments in the chatbot (so-called Reinforcement Learning from Human Feedback (RLHF)) [<span>8</span>]. OpenAI acknowledged this issue: “On April 25th, we rolled out an update to GPT-4o in ChatGPT that made the model noticeably more sycophantic. It aimed to please the user, not just as flattery, but also as
{"title":"Generative Artificial Intelligence Chatbots and Delusions: From Guesswork to Emerging Cases","authors":"Søren Dinesen Østergaard","doi":"10.1111/acps.70022","DOIUrl":"10.1111/acps.70022","url":null,"abstract":"<p>When I proposed the hypothesis that generative artificial intelligence chatbots (chatbots hereafter) might trigger delusions in individuals prone to psychosis in August 2023 [<span>1</span>], I was venturing into unknown territory. Indeed, in the virtual absence of evidence, the editorial was merely based on guesswork—stemming from my own use of these chatbots and my interest in the mechanisms underlying and driving delusions.</p><p>Following publication of the editorial, my charting of the territory slowly began as I started to receive the occasional email from chatbot users, their worried family members, and journalists. Most of these emails described situations where users' interactions with chatbots seemed to spark or bolster delusional ideation. The stories differed with regard to the specific topic at hand but were yet very similar: Consistently, the chatbots seemed to interact with the users in ways that aligned with, or intensified, prior unusual ideas or false beliefs—leading the users further out on these tangents, not rarely resulting in what, based on the descriptions, seemed to be outright delusions.</p><p>Over the past couple of months, I have noticed that the number of emails I have received on this topic from near and far has only increased. I have been working with psychiatric research for more than 15 years and can say, without a doubt, that none of my prior publications have led to this level of direct engagement with the public. Coinciding completely with the increase in the number of correspondences, the number of views of my 2023 editorial suddenly spiked dramatically, rising from a very modest plateau around 100 per month to approximately 750 views in May 2025 and 1375 views in June 2025.</p><p>The time trend described above has been paralleled by media coverage of the topic. Indeed, the New York Times [<span>2</span>], Rolling Stone [<span>3</span>], and many other outlets have published articles based on interviews and accounts from online fora [<span>4</span>] that are all compatible with people experiencing onset or worsening of delusions during intense and typically long interactions with chatbots (that do not grow tired of chatting) [<span>2</span>].</p><p>The timing of this spike in the focus on potential chatbot-fuelled delusions is likely not random as it coincided with the April 25th 2025 update to the GPT-4o model—a recent version of the popular ChatGPT chatbot from OpenAI [<span>5-7</span>]. This model has been accused of being overly “sycophantic” (insincerely affirming and flattering) toward users, caused by the model training leaning too hard on user preferences communicated via thumbs-up/thumbs-down assessments in the chatbot (so-called Reinforcement Learning from Human Feedback (RLHF)) [<span>8</span>]. OpenAI acknowledged this issue: “On April 25th, we rolled out an update to GPT-4o in ChatGPT that made the model noticeably more sycophantic. It aimed to please the user, not just as flattery, but also as","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"257-259"},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783001","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}
Whether younger age at diagnosis of coronary heart disease (CHD) is associated with a higher risk of incident depression and anxiety or not remains unexamined. This study aimed to explore the association between age at diagnosis of CHD and incident depression and anxiety.
Methods
Data were from the UK Biobank. Information on the diagnosis of CHD, depression, and anxiety was collected at baseline and follow-ups. Cox proportional hazards models and the propensity score matching method were applied.
Results
A total of 438,376 adults were included, of which 49,620 had CHD (median follow-up: 13.8 years). Compared with participants without CHD, participants with CHD were at an increased risk of incident depression and anxiety. Younger age at diagnosis of CHD (per 10-year decrement) was associated with a higher risk of depression (HR = 1.73, 95% CI: 1.65–1.82, p < 0.001) and anxiety (HR = 1.66, 95% CI: 1.57–1.74, p < 0.001). In propensity score matching analysis, CHD patients were at a higher risk of depression and anxiety than matched controls without CHD among all diagnosis age groups, and the HRs gradually elevated with descending age at CHD diagnosis.
Conclusions
Individuals diagnosed with CHD at a younger age were at an elevated risk of incident depression and anxiety than individuals diagnosed at an older age, underscoring the necessity to pay attention to their mental health and conduct timely interventions to attenuate the subsequent risk of depression and anxiety.
{"title":"Association Between Age at Diagnosis of Coronary Heart Disease and Incident Depression and Anxiety","authors":"Jie Liang, Qiongwei Li, Yang Pan, Wenya Zhang, Darui Gao, Yanyu Zhang, Jingya Ma, Yuling Liu, Yiwen Dai, Mengmeng Ji, Menghan Zhu, Xvyang Diao, Xinqing Yang, Yichi Zhang, Wuxiang Xie, Fanfan Zheng","doi":"10.1111/acps.70021","DOIUrl":"10.1111/acps.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether younger age at diagnosis of coronary heart disease (CHD) is associated with a higher risk of incident depression and anxiety or not remains unexamined. This study aimed to explore the association between age at diagnosis of CHD and incident depression and anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were from the UK Biobank. Information on the diagnosis of CHD, depression, and anxiety was collected at baseline and follow-ups. Cox proportional hazards models and the propensity score matching method were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 438,376 adults were included, of which 49,620 had CHD (median follow-up: 13.8 years). Compared with participants without CHD, participants with CHD were at an increased risk of incident depression and anxiety. Younger age at diagnosis of CHD (per 10-year decrement) was associated with a higher risk of depression (HR = 1.73, 95% CI: 1.65–1.82, <i>p</i> < 0.001) and anxiety (HR = 1.66, 95% CI: 1.57–1.74, <i>p</i> < 0.001). In propensity score matching analysis, CHD patients were at a higher risk of depression and anxiety than matched controls without CHD among all diagnosis age groups, and the HRs gradually elevated with descending age at CHD diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals diagnosed with CHD at a younger age were at an elevated risk of incident depression and anxiety than individuals diagnosed at an older age, underscoring the necessity to pay attention to their mental health and conduct timely interventions to attenuate the subsequent risk of depression and anxiety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 6","pages":"422-431"},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783000","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}
Natalia E. Fares-Otero, Anaid Pérez-Ramos, Ricardo Lopez-Escribano, Sara Martin-Parra, Luis Alameda, Sarah L. Halligan, Kamilla W. Miskowiak, Eduard Vieta
{"title":"Response to: “In the Assessment of Childhood Maltreatment and Cognitive Function in Bipolar Disorder All Variables Should be Taken Into Consideration”","authors":"Natalia E. Fares-Otero, Anaid Pérez-Ramos, Ricardo Lopez-Escribano, Sara Martin-Parra, Luis Alameda, Sarah L. Halligan, Kamilla W. Miskowiak, Eduard Vieta","doi":"10.1111/acps.70020","DOIUrl":"10.1111/acps.70020","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"399-401"},"PeriodicalIF":5.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783002","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":"Cognition in Psychiatry: Treatment Targets, Mechanisms, and Assessment Innovations.","authors":"Kamilla W Miskowiak, Katherine E Burdick","doi":"10.1111/acps.70015","DOIUrl":"https://doi.org/10.1111/acps.70015","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688431","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}
Introduction: Residual cognitive deficits are commonly reported by individuals in remission from depression, often affecting daily life functioning and mental health. To provide tailored and personalized cognitive enhancement interventions for this population, there is a need for a better understanding of the characteristics of those who benefit from such interventions. Therefore, this study aimed to identify predictors of changes in subjective executive functioning following an internet-delivered cognitive enhancement intervention for adults in remission from depression.
Methods: Data were collected from a randomized controlled trial investigating the efficacy of an internet-delivered cognitive enhancement intervention. Changes in subjective executive functioning from pre-treatment to the six-month follow-up were assessed in 44 participants in remission from depression, using the Behavior Rating Inventory of Executive Function Adult Global Executive Composite. Linear mixed model analyses were conducted to investigate the impact of demographic, clinical, and treatment credibility variables on change in subjective cognitive functioning over time.
Results: The results showed that shorter lifetime depression duration predicted greater improvements in subjective executive functioning (p = 0.031). Higher levels of treatment expectancy and credibility were related to greater improvements in subjective cognitive functioning (p = 0.024). Participants with a partner showed better treatment response than those without a partner (p < 0.001).
Conclusion: This study builds on previous research on cognitive enhancement interventions in remitted depression, highlighting the impact of depression duration, treatment expectancy, and credibility on treatment response. Interventions targeting cognitive deficits appear most effective for those with a shorter lifetime duration of depression. Therefore, efforts should be made to enhance outcomes in those with a chronic course. To maximize engagement and outcomes, these interventions should be delivered in a way that individuals in remission from depression view them as credible and capable of reducing their deficits. Previous research has not found partner status to predict change in subjective executive functioning. The effect of partner status on treatment response should be investigated further.
{"title":"Predictors of Improvement in Subjective Executive Functioning Following an Internet-Delivered Cognitive Enhancement Intervention for Adults in Remission From Depression.","authors":"Sunniva Brurok Myklebost, Tine Nordgreen, Eivind Haga Ronold, Aleksander Heltne, Åsa Hammar","doi":"10.1111/acps.70019","DOIUrl":"https://doi.org/10.1111/acps.70019","url":null,"abstract":"<p><strong>Introduction: </strong>Residual cognitive deficits are commonly reported by individuals in remission from depression, often affecting daily life functioning and mental health. To provide tailored and personalized cognitive enhancement interventions for this population, there is a need for a better understanding of the characteristics of those who benefit from such interventions. Therefore, this study aimed to identify predictors of changes in subjective executive functioning following an internet-delivered cognitive enhancement intervention for adults in remission from depression.</p><p><strong>Methods: </strong>Data were collected from a randomized controlled trial investigating the efficacy of an internet-delivered cognitive enhancement intervention. Changes in subjective executive functioning from pre-treatment to the six-month follow-up were assessed in 44 participants in remission from depression, using the Behavior Rating Inventory of Executive Function Adult Global Executive Composite. Linear mixed model analyses were conducted to investigate the impact of demographic, clinical, and treatment credibility variables on change in subjective cognitive functioning over time.</p><p><strong>Results: </strong>The results showed that shorter lifetime depression duration predicted greater improvements in subjective executive functioning (p = 0.031). Higher levels of treatment expectancy and credibility were related to greater improvements in subjective cognitive functioning (p = 0.024). Participants with a partner showed better treatment response than those without a partner (p < 0.001).</p><p><strong>Conclusion: </strong>This study builds on previous research on cognitive enhancement interventions in remitted depression, highlighting the impact of depression duration, treatment expectancy, and credibility on treatment response. Interventions targeting cognitive deficits appear most effective for those with a shorter lifetime duration of depression. Therefore, efforts should be made to enhance outcomes in those with a chronic course. To maximize engagement and outcomes, these interventions should be delivered in a way that individuals in remission from depression view them as credible and capable of reducing their deficits. Previous research has not found partner status to predict change in subjective executive functioning. The effect of partner status on treatment response should be investigated further.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673385","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}
Alicia Nevriana, Emma Brulin, Tomas Hemmingsson, Melody Almroth, Kuan-Yu Pan, Theo Bodin, Katarina Kjellberg, Daniel Falkstedt
Introduction
Many studies have examined physicians' risk of suicide, but studies of other healthcare occupations have been fewer. Suicide attempts have also rarely been studied. We aimed to determine the risks of suicide and suicide attempts among healthcare workers in comparison with non-healthcare workers, according to occupational qualification level.
Methods
This population-based cohort study linking Swedish national registers included 243,183 healthcare workers in high-qualified occupations (e.g., physicians); 1,789,076 workers in other high-qualified occupations; 514,726 healthcare workers in low-qualified occupations (e.g., assistant nurses); and 2,026,890 workers in low-qualified occupations residing in Sweden in 2005 and followed them until the latest December 31, 2020. We estimated adjusted hazard ratios (aHR) for suicide and first suicide attempt.
Results
Compared to non-healthcare workers, higher risks for suicide were observed for several healthcare occupations, primarily those working with patient care (e.g., aHR physicians 1.57, 95% CI: 1.23–2.00, registered nurses 1.61, 95% CI: 1.37–1.88, assistant nurses 1.25, 95% CI: 1.17–1.34), rather than those in administrative roles (aHR high-qualified healthcare administrators 1.01 95% CI: 0.76–1.35). Among physicians, the risk was most apparent for psychiatrists (aHR 2.70, 95% CI: 1.21–6.03). For suicide attempts, the risks were primarily observed among registered nurses (aHR 1.22, 95% CI: 1.15–1.29) and assistant nurses (aHR 1.15, 95% CI: 1.12–1.18). Among healthcare workers, assistant nurses had the highest incidence rates for suicide (18.7/100,000 person-years) and suicide attempts (175.1/100,000 person-years).
Conclusions
Workers in several healthcare occupations showed a higher risk of suicide relative to non-healthcare workers with a similar occupational qualification level. Interventions may need to be developed to reduce the risk of suicidal behavior in these groups.
{"title":"Healthcare Occupations, Suicides, and Suicide Attempts: A Cohort Study Based on the Working Population in Sweden","authors":"Alicia Nevriana, Emma Brulin, Tomas Hemmingsson, Melody Almroth, Kuan-Yu Pan, Theo Bodin, Katarina Kjellberg, Daniel Falkstedt","doi":"10.1111/acps.70018","DOIUrl":"10.1111/acps.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Many studies have examined physicians' risk of suicide, but studies of other healthcare occupations have been fewer. Suicide attempts have also rarely been studied. We aimed to determine the risks of suicide and suicide attempts among healthcare workers in comparison with non-healthcare workers, according to occupational qualification level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This population-based cohort study linking Swedish national registers included 243,183 healthcare workers in high-qualified occupations (e.g., physicians); 1,789,076 workers in other high-qualified occupations; 514,726 healthcare workers in low-qualified occupations (e.g., assistant nurses); and 2,026,890 workers in low-qualified occupations residing in Sweden in 2005 and followed them until the latest December 31, 2020. We estimated adjusted hazard ratios (aHR) for suicide and first suicide attempt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to non-healthcare workers, higher risks for suicide were observed for several healthcare occupations, primarily those working with patient care (e.g., aHR physicians 1.57, 95% CI: 1.23–2.00, registered nurses 1.61, 95% CI: 1.37–1.88, assistant nurses 1.25, 95% CI: 1.17–1.34), rather than those in administrative roles (aHR high-qualified healthcare administrators 1.01 95% CI: 0.76–1.35). Among physicians, the risk was most apparent for psychiatrists (aHR 2.70, 95% CI: 1.21–6.03). For suicide attempts, the risks were primarily observed among registered nurses (aHR 1.22, 95% CI: 1.15–1.29) and assistant nurses (aHR 1.15, 95% CI: 1.12–1.18). Among healthcare workers, assistant nurses had the highest incidence rates for suicide (18.7/100,000 person-years) and suicide attempts (175.1/100,000 person-years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Workers in several healthcare occupations showed a higher risk of suicide relative to non-healthcare workers with a similar occupational qualification level. Interventions may need to be developed to reduce the risk of suicidal behavior in these groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"360-371"},"PeriodicalIF":5.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673384","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}
Mikko Niskanen, Olli Kärkkäinen, Heidi Taipale, Johannes Lieslehto, Jari Tiihonen, Aleksi Hamina
Background
Individuals with bipolar disorder face an elevated risk of premature death, often due to external causes such as accidental injuries, self-harm, and substance-related deaths. This study aimed to investigate the incidence of severe poisonings among individuals with bipolar disorder and to examine associated demographic and clinical factors.
Methods
We conducted a cohort study using data from national registers in Finland, measuring hospitalizations and deaths due to poisoning by medicines or illegal substances in 1996–2018. Cox proportional hazards regression models were used to assess associations between predictor variables and poisoning outcomes.
Results
The study population comprised 60,045 individuals aged 15–65 diagnosed with bipolar disorder in 1987–2018. During the study period, 13.1% (N = 7872) of the population experienced at least one poisoning resulting in hospitalization or death. The age-standardized rate of hospitalizations was 50.6 (95% CI, 49.5–51.7) per 1000 person-years and of deaths 1.8 (95% CI, 1.6–2.0) per 1000 person-years. The majority of poisonings leading to hospitalization (59.1%) or death (56.6%) were intentional and caused by pharmaceuticals (hospitalizations, 76.9%; deaths, 63.6%). Additionally, psychoactive narcotics and stimulants were the cause of 26.8% of the poisoning deaths. The strongest risk factors for hospitalization were substance use disorder (adjusted hazard ratio, aHR, 2.75, 95% CI, 2.61–2.90) and a history of suicide attempt (2.70, 2.52–2.88). The risk of poisoning death was most strongly associated with substance use disorder (3.02, 2.60–3.52) and a history of suicide attempt (2.38, 1.94–2.91). Female sex was associated with a higher risk of hospitalization (1.19, 1.14–1.25), but a lower risk of death (0.72, 0.62–0.82).
Conclusion
Individuals with bipolar disorder face a substantial risk of poisoning by medicines or illegal substances, with notable sex differences in hospitalization and death rates. Key risk factors include substance use disorder and a history of suicide attempt.
{"title":"Bipolar Disorder and Poisoning due to Medicines or Illegal Substances","authors":"Mikko Niskanen, Olli Kärkkäinen, Heidi Taipale, Johannes Lieslehto, Jari Tiihonen, Aleksi Hamina","doi":"10.1111/acps.70017","DOIUrl":"10.1111/acps.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with bipolar disorder face an elevated risk of premature death, often due to external causes such as accidental injuries, self-harm, and substance-related deaths. This study aimed to investigate the incidence of severe poisonings among individuals with bipolar disorder and to examine associated demographic and clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using data from national registers in Finland, measuring hospitalizations and deaths due to poisoning by medicines or illegal substances in 1996–2018. Cox proportional hazards regression models were used to assess associations between predictor variables and poisoning outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study population comprised 60,045 individuals aged 15–65 diagnosed with bipolar disorder in 1987–2018. During the study period, 13.1% (<i>N</i> = 7872) of the population experienced at least one poisoning resulting in hospitalization or death. The age-standardized rate of hospitalizations was 50.6 (95% CI, 49.5–51.7) per 1000 person-years and of deaths 1.8 (95% CI, 1.6–2.0) per 1000 person-years. The majority of poisonings leading to hospitalization (59.1%) or death (56.6%) were intentional and caused by pharmaceuticals (hospitalizations, 76.9%; deaths, 63.6%). Additionally, psychoactive narcotics and stimulants were the cause of 26.8% of the poisoning deaths. The strongest risk factors for hospitalization were substance use disorder (adjusted hazard ratio, aHR, 2.75, 95% CI, 2.61–2.90) and a history of suicide attempt (2.70, 2.52–2.88). The risk of poisoning death was most strongly associated with substance use disorder (3.02, 2.60–3.52) and a history of suicide attempt (2.38, 1.94–2.91). Female sex was associated with a higher risk of hospitalization (1.19, 1.14–1.25), but a lower risk of death (0.72, 0.62–0.82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals with bipolar disorder face a substantial risk of poisoning by medicines or illegal substances, with notable sex differences in hospitalization and death rates. Key risk factors include substance use disorder and a history of suicide attempt.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"299-307"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657913","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}
Ikbal Andrian Malau, Ying-Ming Chiu, Hui-Chih Chang, Ya-Chu Yang, Jane Pei-Chen Chang, Christoph U. Correll, Vieta Eduard, Kuan-Pin Su
Introduction
Bipolar disorder (BD) significantly affects life expectancy (LE), results in substantial loss of LE, and contributes to high medical costs, with these impacts varying by age at onset and gender. Previous studies have often overlooked the significance of age at the onset when estimating LE in individuals with BD. This study aimed to address this limitation and assess the impacts of BD on LE, loss of LE, and medical costs for BD patients categorized by age and gender in Taiwan using a new semiparametric extrapolation method over an 11-year duration.
Methods
A rolling-over algorithm estimated the survival function, with lifetime risk extrapolated. LE and loss of LE were calculated by comparing BD patients to matched non-BD referents by sex, age, and diagnosis year. Lifetime medical costs were determined by multiplying average monthly expenses by survival rates. Data from Taiwan's National Health Insurance (2009–2019) identified BD patients aged 5–84 with ≥ 2 outpatient or ≥ 1 inpatient BD diagnosis. The semiparametric survival extrapolation method was validated by comparing it with the Kaplan–Meier analysis.
Results
The results indicate that following a BD diagnosis, patients have an LE of 26.79 years, reflecting a loss of 15.08 years compared to matched referents. On average, patients with BD incurred annual medical expenses of around $2516, with costs rising with age for both sexes. The mean estimated lifetime cost for the study population was about $55,015. The extrapolation method demonstrated high accuracy, with a less than 5% relative bias.
Conclusion
Semiparametric extrapolation is an effective method for estimating LE, loss of LE, and lifetime costs in BD. Future work could refine semiparametric extrapolation and assess factors influencing LE loss and lifetime costs in BD.
{"title":"Life Expectancy, Loss of Life Expectancy, and Lifetime Costs in Bipolar Disorder: A Nationwide Population-Based Study","authors":"Ikbal Andrian Malau, Ying-Ming Chiu, Hui-Chih Chang, Ya-Chu Yang, Jane Pei-Chen Chang, Christoph U. Correll, Vieta Eduard, Kuan-Pin Su","doi":"10.1111/acps.70013","DOIUrl":"10.1111/acps.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) significantly affects life expectancy (LE), results in substantial loss of LE, and contributes to high medical costs, with these impacts varying by age at onset and gender. Previous studies have often overlooked the significance of age at the onset when estimating LE in individuals with BD. This study aimed to address this limitation and assess the impacts of BD on LE, loss of LE, and medical costs for BD patients categorized by age and gender in Taiwan using a new semiparametric extrapolation method over an 11-year duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A rolling-over algorithm estimated the survival function, with lifetime risk extrapolated. LE and loss of LE were calculated by comparing BD patients to matched non-BD referents by sex, age, and diagnosis year. Lifetime medical costs were determined by multiplying average monthly expenses by survival rates. Data from Taiwan's National Health Insurance (2009–2019) identified BD patients aged 5–84 with ≥ 2 outpatient or ≥ 1 inpatient BD diagnosis. The semiparametric survival extrapolation method was validated by comparing it with the Kaplan–Meier analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicate that following a BD diagnosis, patients have an LE of 26.79 years, reflecting a loss of 15.08 years compared to matched referents. On average, patients with BD incurred annual medical expenses of around $2516, with costs rising with age for both sexes. The mean estimated lifetime cost for the study population was about $55,015. The extrapolation method demonstrated high accuracy, with a less than 5% relative bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Semiparametric extrapolation is an effective method for estimating LE, loss of LE, and lifetime costs in BD. Future work could refine semiparametric extrapolation and assess factors influencing LE loss and lifetime costs in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 5","pages":"350-359"},"PeriodicalIF":5.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641299","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}
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