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.
{"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":"10.1111/acps.13739","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"401-411"},"PeriodicalIF":5.3,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13739","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<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":"<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","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}
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, Fredrik Hieronymus, Søren Dinesen Østergaard","doi":"10.1111/acps.13729","DOIUrl":"10.1111/acps.13729","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\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}
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.
{"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, 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","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}
Susana Gomes-da-Costa, Isabel Fernandéz-Pérez, Roger Borras, Noelia Lopez, Yudith Rivas, Victoria Ruiz, Maria Teresa Pons-Cabrera, Anna Giménez-Palomo, Gerard Anmella, Marc Valentí, Michael Berk, Eduard Vieta, Isabella Pacchiarotti
Background
Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health. The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.
Methods
The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.
Results
Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.
Conclusions
A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.
{"title":"Is a vegetarian diet beneficial for bipolar disorder? Relationship between dietary patterns, exercise and pharmacological treatments with metabolic syndrome and course of disease in bipolar disorder","authors":"Susana Gomes-da-Costa, Isabel Fernandéz-Pérez, Roger Borras, Noelia Lopez, Yudith Rivas, Victoria Ruiz, Maria Teresa Pons-Cabrera, Anna Giménez-Palomo, Gerard Anmella, Marc Valentí, Michael Berk, Eduard Vieta, Isabella Pacchiarotti","doi":"10.1111/acps.13733","DOIUrl":"10.1111/acps.13733","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health. The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"209-222"},"PeriodicalIF":5.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141588997","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}
Lisa-Marie Hartnagel, Ulrich W. Ebner-Priemer, Jerome C. Foo, Fabian Streit, Stephanie H. Witt, Josef Frank, Matthias F. Limberger, Andrea B. Horn, Maria Gilles, Marcella Rietschel, Lea Sirignano
Background
Digital phenotyping and monitoring tools are the most promising approaches to automatically detect upcoming depressive episodes. Especially, linguistic style has been seen as a potential behavioral marker of depression, as cross-sectional studies showed, for example, less frequent use of positive emotion words, intensified use of negative emotion words, and more self-references in patients with depression compared to healthy controls. However, longitudinal studies are sparse and therefore it remains unclear whether within-person fluctuations in depression severity are associated with individuals' linguistic style.
Methods
To capture affective states and concomitant speech samples longitudinally, we used an ambulatory assessment approach sampling multiple times a day via smartphones in patients diagnosed with depressive disorder undergoing sleep deprivation therapy. This intervention promises a rapid change of affective symptoms within a short period of time, assuring sufficient variability in depressive symptoms. We extracted word categories from the transcribed speech samples using the Linguistic Inquiry and Word Count.
Results
Our analyses revealed that more pleasant affective momentary states (lower reported depression severity, lower negative affective state, higher positive affective state, (positive) valence, energetic arousal and calmness) are mirrored in the use of less negative emotion words and more positive emotion words.
Conclusion
We conclude that a patient's linguistic style, especially the use of positive and negative emotion words, is associated with self-reported affective states and thus is a promising feature for speech-based automated monitoring and prediction of upcoming episodes, ultimately leading to better patient care.
{"title":"Linguistic style as a digital marker for depression severity: An ambulatory assessment pilot study in patients with depressive disorder undergoing sleep deprivation therapy","authors":"Lisa-Marie Hartnagel, Ulrich W. Ebner-Priemer, Jerome C. Foo, Fabian Streit, Stephanie H. Witt, Josef Frank, Matthias F. Limberger, Andrea B. Horn, Maria Gilles, Marcella Rietschel, Lea Sirignano","doi":"10.1111/acps.13726","DOIUrl":"10.1111/acps.13726","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digital phenotyping and monitoring tools are the most promising approaches to automatically detect upcoming depressive episodes. Especially, linguistic style has been seen as a potential behavioral marker of depression, as cross-sectional studies showed, for example, less frequent use of positive emotion words, intensified use of negative emotion words, and more self-references in patients with depression compared to healthy controls. However, longitudinal studies are sparse and therefore it remains unclear whether within-person fluctuations in depression severity are associated with individuals' linguistic style.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To capture affective states and concomitant speech samples longitudinally, we used an ambulatory assessment approach sampling multiple times a day via smartphones in patients diagnosed with depressive disorder undergoing sleep deprivation therapy. This intervention promises a rapid change of affective symptoms within a short period of time, assuring sufficient variability in depressive symptoms. We extracted word categories from the transcribed speech samples using the Linguistic Inquiry and Word Count.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analyses revealed that more pleasant affective momentary states (lower reported depression severity, lower negative affective state, higher positive affective state, (positive) valence, energetic arousal and calmness) are mirrored in the use of less negative emotion words and more positive emotion words.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We conclude that a patient's linguistic style, especially the use of positive and negative emotion words, is associated with self-reported affective states and thus is a promising feature for speech-based automated monitoring and prediction of upcoming episodes, ultimately leading to better patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"348-357"},"PeriodicalIF":5.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor concerning “Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression”","authors":"Margarida Alves, Diana Durães, Pedro Afonso","doi":"10.1111/acps.13732","DOIUrl":"10.1111/acps.13732","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"245-246"},"PeriodicalIF":5.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578332","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}
Olivier Corbeil, Élizabeth Anderson, Laurent Béchard, Charles Desmeules, Maxime Huot-Lavoie, Lauryann Bachand, Sébastien Brodeur, Pierre-Hugues Carmichael, Christian Jacques, Marco Solmi, Isabelle Giroux, Michel Dorval, Marie-France Demers, Marc-André Roy
{"title":"Reply to: Why does problem gambling in psychotic disorders pose such a challenge for comprehension?","authors":"Olivier Corbeil, Élizabeth Anderson, Laurent Béchard, Charles Desmeules, Maxime Huot-Lavoie, Lauryann Bachand, Sébastien Brodeur, Pierre-Hugues Carmichael, Christian Jacques, Marco Solmi, Isabelle Giroux, Michel Dorval, Marie-France Demers, Marc-André Roy","doi":"10.1111/acps.13730","DOIUrl":"10.1111/acps.13730","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 1","pages":"102-104"},"PeriodicalIF":5.3,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544197","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}
This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024.
Method
Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review.
Results
MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes.
Conclusions
MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.
{"title":"A systematic review of research examining mothers, infants, family and staff in psychiatric mother-baby units","authors":"Sam Adhikary, Kerri Gillespie, Hayley Kimball, Lyndall Healey, Olivia Webb, Abha Balram, Grace Branjerdporn","doi":"10.1111/acps.13727","DOIUrl":"10.1111/acps.13727","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"284-307"},"PeriodicalIF":5.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490086","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}
Pelle Lau Ishøy, Kim Berg Engersgaard Johannessen, Tine Houmann, Eline Levin, Per Hove Thomsen
<div> <section> <h3> Introduction</h3> <p>Attention deficit hyperactivity disorder (ADHD) medication has proven effective for treating ADHD in adults, nonetheless previous studies have shown high rates of medication discontinuation.</p> </section> <section> <h3> Objective</h3> <p>To assess drug survival and identify risk factors associated with discontinuation of ADHD medication.</p> </section> <section> <h3> Methods</h3> <p>A nationwide registry-based cohort study in Danish adults who redeemed a prescription for ADHD medication for the first time between 2010 and 2015. All patients were followed for 5 years from the first redeemed prescription. Discontinuation was defined as a gap of 12 months between redemptions. Logistic regression analysis with odds ratio (OR) and Kaplan Meier analysis were used to examine risk factors (sex, age, socioeconomic status, substance use disorders, and comorbidities) associated with discontinuation.</p> </section> <section> <h3> Results</h3> <p>Twenty three thousand nine-hundred and sixteen patients with ADHD were identified. The 5-year overall drug survival was 29% in women vs. 23.5% in men. The risk of medication discontinuation was significantly higher in men compared to women, OR 1.26 (95% CI 1.19–1.34, <i>p</i> < 0.001). Adults aged 31–50 years had a significantly decreased risk of medication discontinuation compared to adults aged 18–30 years, OR 0.57 (95% CI 0.53–0.61, <i>p</i> < 0.001). Switching ADHD medication two times or three times or more significantly decreased the risk of discontinuation; OR 0.53 (95% CI 0.49–0.56, <i>p</i> < 0.001) and OR 0.26 (95% CI 0.23–0.30, <i>p</i> < 0.001), respectively. Substance use disorders and certain comorbidities were associated with medication discontinuation. Eating disorders, OR 0.71 (95% CI 0.64–0.78, <i>p</i> < 0.001), intellectual disabilities, OR 0.65 (95% CI 0.59–0.73, <i>p</i> < 0.001) and sleep disorders, OR 0.42 (95% CI 0.37–0.49, <i>p</i> < 0.001) were associated with continuation of ADHD medication.</p> </section> <section> <h3> Conclusions</h3> <p>The 5-year overall drug survival was longer in women compared to men. Women with ADHD; adults aged 31–50; and patients with comorbid eating disorder; intellectual disability; sleep disorder and medication switching were individually associated with continuation of ADHD medication. Various factors were associated with medication discontinuation. Discontinuation should be acknowledged as a comm
{"title":"Drug survival and risk factors for ADHD medication discontinuation in adults: A Danish Nationwide Registry-based cohort study","authors":"Pelle Lau Ishøy, Kim Berg Engersgaard Johannessen, Tine Houmann, Eline Levin, Per Hove Thomsen","doi":"10.1111/acps.13724","DOIUrl":"10.1111/acps.13724","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Attention deficit hyperactivity disorder (ADHD) medication has proven effective for treating ADHD in adults, nonetheless previous studies have shown high rates of medication discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess drug survival and identify risk factors associated with discontinuation of ADHD medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide registry-based cohort study in Danish adults who redeemed a prescription for ADHD medication for the first time between 2010 and 2015. All patients were followed for 5 years from the first redeemed prescription. Discontinuation was defined as a gap of 12 months between redemptions. Logistic regression analysis with odds ratio (OR) and Kaplan Meier analysis were used to examine risk factors (sex, age, socioeconomic status, substance use disorders, and comorbidities) associated with discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty three thousand nine-hundred and sixteen patients with ADHD were identified. The 5-year overall drug survival was 29% in women vs. 23.5% in men. The risk of medication discontinuation was significantly higher in men compared to women, OR 1.26 (95% CI 1.19–1.34, <i>p</i> < 0.001). Adults aged 31–50 years had a significantly decreased risk of medication discontinuation compared to adults aged 18–30 years, OR 0.57 (95% CI 0.53–0.61, <i>p</i> < 0.001). Switching ADHD medication two times or three times or more significantly decreased the risk of discontinuation; OR 0.53 (95% CI 0.49–0.56, <i>p</i> < 0.001) and OR 0.26 (95% CI 0.23–0.30, <i>p</i> < 0.001), respectively. Substance use disorders and certain comorbidities were associated with medication discontinuation. Eating disorders, OR 0.71 (95% CI 0.64–0.78, <i>p</i> < 0.001), intellectual disabilities, OR 0.65 (95% CI 0.59–0.73, <i>p</i> < 0.001) and sleep disorders, OR 0.42 (95% CI 0.37–0.49, <i>p</i> < 0.001) were associated with continuation of ADHD medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 5-year overall drug survival was longer in women compared to men. Women with ADHD; adults aged 31–50; and patients with comorbid eating disorder; intellectual disability; sleep disorder and medication switching were individually associated with continuation of ADHD medication. Various factors were associated with medication discontinuation. Discontinuation should be acknowledged as a comm","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"160-173"},"PeriodicalIF":5.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490103","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}
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