Acta Psychiatrica Scandinavica最新文献_第7页

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 素食对躁郁症有益吗？躁郁症患者的饮食模式、运动和药物治疗与代谢综合征和病程之间的关系。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-12 DOI: 10.1111/acps.13733

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.

背景：由于生活方式可能对躁狂症（BD）的病程和身体健康产生影响，人们对其进行了越来越多的研究。本研究旨在共同描述和探讨饮食模式、运动、药物治疗与躁狂症病程和代谢状况之间的相互关系：方法：研究样本包括 66 名抑郁症患者或轻度抑郁症患者。对临床和代谢结果以及药物治疗或生活习惯（饮食和运动）进行了评估。研究人员探讨了不同相互关系，并对饮食模式进行了因子分析：结果：37.9%的患者坚持地中海饮食，但坚持率较低，且与生活质量呈正相关。运动量与胆固醇水平呈负相关，32.8%的参与者在国际体育活动问卷调查中被评为运动量低。肥胖（40.6%）和代谢综合征（29.7%）的发病率很高。锂盐使用者的代谢状况最好。有趣的是，研究发现了三种饮食模式："素食"、"杂食 "和 "西式"。主要发现是 "素食 "模式对 BD 的整体积极影响，它与抑郁评分降低、社会心理功能改善、生活质量感知提高、体重指数、胆固醇、低密度脂蛋白和舒张压降低有关。食用坚果与更好的代谢状况有关：结论：素食模式与 BD 患者更好的临床和代谢指标相关。未来的研究应优先考虑前瞻性和随机设计，以确定因果关系，并为临床建议提供潜在依据。

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引用次数: 0

Linguistic style as a digital marker for depression severity: An ambulatory assessment pilot study in patients with depressive disorder undergoing sleep deprivation therapy 作为抑郁症严重程度数字标记的语言风格：对接受睡眠剥夺疗法的抑郁症患者进行流动评估试点研究。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-10 DOI: 10.1111/acps.13726

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.

背景：数字表型和监测工具是自动检测即将到来的抑郁发作的最有前途的方法。特别是，语言风格被视为抑郁症的潜在行为标记，因为横断面研究显示，与健康对照组相比，抑郁症患者较少使用积极情绪词，更多使用消极情绪词，自我暗示更多。然而，纵向研究却很少，因此，抑郁症严重程度在人体内的波动是否与个人的语言风格有关仍不清楚：为了纵向捕捉情感状态和伴随的语言样本，我们采用了一种流动评估方法，每天通过智能手机对接受睡眠剥夺疗法的抑郁症患者进行多次采样。这种干预措施有望在短时间内迅速改变患者的情绪症状，从而确保抑郁症状具有足够的可变性。我们使用语言调查和词汇计数法从转录的语音样本中提取了词汇类别：我们的分析表明，较愉快的情绪瞬间状态（较低的抑郁严重程度、较低的消极情绪状态、较高的积极情绪状态、（积极的）价值、精力充沛的唤醒和平静）反映在较少的消极情绪词和较多的积极情绪词的使用上：我们得出的结论是，患者的语言风格，尤其是积极和消极情绪词的使用，与自我报告的情绪状态相关，因此是基于语音的自动监测和预测即将发作的疾病的一个很有前景的特征，最终可为患者提供更好的护理。

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引用次数: 0

Letter to the Editor concerning “Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression” 致编辑的信，内容涉及 "精神病性单相抑郁症维持阶段的电休克疗法"。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-10 DOI: 10.1111/acps.13732

Margarida Alves, Diana Durães, Pedro Afonso

引用次数: 0

Reply to: Why does problem gambling in psychotic disorders pose such a challenge for comprehension? 答复为什么精神病性障碍中的问题赌博会给理解工作带来如此大的挑战？

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-05 DOI: 10.1111/acps.13730

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

引用次数: 0

A systematic review of research examining mothers, infants, family and staff in psychiatric mother-baby units 对精神科母婴病房的母亲、婴儿、家庭和工作人员的研究进行系统回顾。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-03 DOI: 10.1111/acps.13727

Sam Adhikary, Kerri Gillespie, Hayley Kimball, Lyndall Healey, Olivia Webb, Abha Balram, Grace Branjerdporn

Objective

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.

目的：本系统性综述旨在总结和归纳 2016 年 1 月 1 日至 2024 年 5 月 1 日期间在精神科母婴病房（MBU）开展的与患者、家属或员工有关的研究：本系统性综述旨在总结和归纳 2016 年 1 月 1 日至 2024 年 5 月 1 日期间发表的有关精神科母婴病房（MBU）患者、家属或员工的研究：如果定量研究、定性研究和混合方法研究发表在同行评审的英文期刊上，并报告了 2016 年 1 月至 2024 年 5 月期间有关母婴病房的研究，则纳入审查范围。在最初产生的 10,007 项独特研究中，有 53 项研究被纳入审查范围：结果发现，与 2016 年之前的研究相比，医疗小组的研究更频繁地调查产妇特征，而非医疗小组治疗的益处。大多数对入院影响进行调查的研究都显示了有利的结果，但很少有后续研究以及将医疗小组的结果与其他临床环境进行比较的研究。很少有研究调查医疗小组入院对不同诊断和长期（>1 年）患者预后的不同影响。对医疗小组中妇女的伴侣进行调查的研究很少，对婴儿结果的研究也很少：结论：研究一致发现，医疗小组能够改善患者的心理健康系统和入院后的母婴依恋关系。需要开展更多的研究，调查病人支持网络和儿童健康、诊断对结果的影响，并进行充分的后续研究。

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引用次数: 0

Drug survival and risk factors for ADHD medication discontinuation in adults: A Danish Nationwide Registry-based cohort study 成人多动症的药物存活率和停药风险因素：一项基于丹麦全国登记处的队列研究。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-07-03 DOI: 10.1111/acps.13724

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

简介：事实证明，注意力缺陷多动障碍（ADHD）药物能有效治疗成人ADHD，但以往的研究表明，药物的停用率很高：评估药物存活率，并确定与停用 ADHD 药物相关的风险因素：方法：对 2010 年至 2015 年间首次兑换 ADHD 药物处方的丹麦成人进行全国性登记队列研究。自首次兑换处方起，对所有患者进行为期 5 年的随访。停药定义为两次换药之间间隔 12 个月。我们采用几率比（OR）逻辑回归分析和卡普兰-梅耶尔分析来研究与停药相关的风险因素（性别、年龄、社会经济地位、药物使用障碍和合并症）：共发现 23916 名多动症患者。女性的 5 年总体药物存活率为 29%，而男性为 23.5%。与女性相比，男性的停药风险明显更高，OR 值为 1.26（95% CI 为 1.19-1.34，p 结论：男性的停药风险明显高于女性，OR 值为 1.26（95% CI 为 1.19-1.34，p）：与男性相比，女性的 5 年总体药物存活期更长。患有多动症的女性、31-50 岁的成年人、合并饮食失调、智力障碍、睡眠障碍和换药的患者与继续服用多动症药物存在个体相关性。多种因素与停药有关。应该承认，停药是多动症患者的常见现象，需要负责治疗的处方医生或团队给予更多关注。此外，我们的研究结果表明，及时、频繁换药或临时用药方案可能确实是相当一部分多动症患者的最佳治疗策略。

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引用次数: 0

The conversation about family planning and desire for children in mental healthcare: Patients' perspective versus Professionals' perspective in a mixed methods study 心理医疗保健中关于计划生育和生育意愿的对话：一项混合方法研究中的患者观点与专业人员观点。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-06-24 DOI: 10.1111/acps.13725

Noralie N. Schonewille, Monique J. M. van den Eijnden, Ruveyda Sahin, Nini H. Jonkman, Anne A. M. W. van Kempen, Maria G. van Pampus, Fedde Scheele, Odile A. van den Heuvel, Birit F. P. Broekman

Background

Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.

Methods

We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.

Results

Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.

Conclusions

To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.

背景：生殖健康与心理健康相互交织，但有关心理保健中计划生育需求和生育意愿的研究却很少：我们研究了（前）患者、与（前）患者关系密切者（亲密者）和精神卫生专业人员（MHP）在讨论精神卫生保健中的计划生育和生育意愿时的经历。我们将定量数据（两次全国范围的调查）和定性数据（四个焦点小组）结合起来，采用混合方法和顺序分析设计：焦点小组（n = 19 名参与者）和两项调查（n = 139 名精神科医生和 n = 294 名（前）患者及亲友）的综合数据显示，相当一部分精神科医生（64.0%）、患者（40.9%）和亲友（50.0%）认为精神科医生应该讨论计划生育问题。然而，一些障碍阻碍了谈话的进行，如害怕被评判、缺乏时间和知识，以及在治疗关系中深入探讨生活主题的机会有限：为了提高患者在讨论计划生育问题时的自主性，我们建议心理保健医生在讨论避孕护理之前，先与所有处于生育期的患者探讨讨论计划生育问题的意愿。医疗保健人员应接受与计划生育和生育愿望相关的精神疾病易感性方面的教育，同时应增强患者及其亲友自己发起对话的能力。

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引用次数: 0

Call for action to address premature mortality due to physical illness in individuals with severe mental disorders 呼吁采取行动，解决严重精神障碍患者因身体疾病过早死亡的问题。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-06-24 DOI: 10.1111/acps.13722

Laurent Boyer, Pierre-Michel Llorca, Guillaume Fond

<p>The study conducted by Tapio Paljärvi et al., titled “Cardiovascular mortality in bipolar disorder: population-based cohort study,” sheds crucial light on the alarming rates of cardiovascular disease mortality among individuals with bipolar disorder.<span><sup>1</sup></span> The findings underscore a significant excess in mortality due to various cardiovascular causes, including coronary artery disease, cardiomyopathy, and hypertensive heart disease. This issue is part of a larger problem for people with severe mental illnesses (SMI), such as schizophrenia, bipolar disorders, and major depressive disorders. Individuals with SMI die up to 15 years earlier than the general population, and around 70% of this mortality gap is due to physical disorders.<span><sup>2</sup></span> Increased risk of physical disorders in those with mental disorders is due to reduced access to adequate physical health monitoring, care and prevention,<span><sup>3-5</sup></span> increased risk of adverse health behaviors<span><sup>6</sup></span> such as sedentary behavior, poor diet, and smoking, comorbid substance abuse, and side effects of psychiatric medications.<span><sup>7</sup></span></p><p>Despite the availability of clinical practice guidelines and evidence-based interventions aimed at reducing excess mortality rates due to physical comorbidities in persons with SMI, the problem still persists. There is a crucial need to better understand how to implement clinical practice guidelines and evidence-based interventions successfully in the real world. Individuals with comorbid mental and physical disorders face specific challenges in service organization, requiring complex treatment and intense resource utilization.<span><sup>8</sup></span> The management of multimorbidity is recognized to be complex, with a high treatment burden in terms of understanding and self-managing the conditions, attending multiple appointments, and managing complex drug regimens.<span><sup>9</sup></span> Evidence suggests that a key part of the problem is the lack of integration of care across service settings. There is major fragmentation in how care is coordinated between family doctors and hospitals, between physical and mental health care, and across health and social care. As proposed by Tapio Paljärvi et al.<span><sup>1</sup></span> and other authors,<span><sup>10</sup></span> person-centered and integrated care models are a critical step to support effective implementation approaches to translate evidence into practice.</p><p>However, despite local and innovative experiences in several countries, the large-scale implementation of integrated care models faces numerous barriers and conservatisms. These obstacles hinder progress and maintain the status quo, perpetuating major health inequalities in individuals with SMI. A call for action in Europe, similar to initiatives already established in the United States,<span><sup>11</sup></span> is necessary. Currently, there are two main types

塔皮奥-帕尔耶尔维（Tapio Paljärvi）等人进行的一项名为 "双相情感障碍患者的心血管疾病死亡率：基于人群的队列研究 "的研究，揭示了双相情感障碍患者心血管疾病死亡率的惊人比率。这个问题是严重精神疾病（SMI）患者（如精神分裂症、双相情感障碍和重度抑郁症）更大问题的一部分。2 精神障碍患者罹患躯体疾病的风险增加是由于获得充分的躯体健康监测、护理和预防的机会减少，3-5 不良健康行为6 的风险增加，如久坐不动、不良饮食习惯、吸烟、合并药物滥用以及精神科药物的副作用等。尽管有临床实践指南和循证干预措施来降低 SMI 患者因身体合并症而导致的超额死亡率，但这一问题仍然存在。我们亟需更好地了解如何在现实世界中成功实施临床实践指南和循证干预措施。8 多病共存的管理被认为是复杂的，在理解和自我管理病情、多次就诊和管理复杂的药物疗程方面，治疗负担很重。9 有证据表明，问题的关键在于缺乏跨服务环境的整合护理。家庭医生和医院之间、身体和精神健康护理之间以及健康和社会护理之间的护理协调非常分散。正如 Tapio Paljärvi 等人1 和其他作者10 所提出的，以人为本的综合护理模式是支持有效实施方法的关键步骤，以将证据转化为实践。然而，尽管在一些国家有地方性的创新经验，但大规模实施综合护理模式仍面临许多障碍和保守主义。这些障碍阻碍了进展，维持了现状，使 SMI 患者在健康方面的重大不平等现象长期存在。有必要在欧洲呼吁采取行动，类似于美国已经采取的行动11。目前，主要有两种综合护理模式：基于初级保健的模式和基于专科精神保健的模式。这些模式似乎针对不同的人群--前者主要针对常见的精神障碍，如焦虑和轻度或中度抑郁，而后者则主要针对 SMI 患者。这种分布源于我们目前的医疗保健系统的组织结构。患有 SMI 的患者通常无法像焦虑症和轻度抑郁症患者那样方便地获得初级医疗服务，而后者则更容易获得初级医疗服务。这两种模式都能提高医疗质量，包括预防、体检和随访。然而，临床结果的改善却不那么明显，这可能是由于健康受到多年来长期起作用的决定因素的影响，而期望迅速改变结果是不现实的。对结果缺乏影响不应削弱这些举措；它们代表了解决这一问题的初步尝试，并提醒我们综合护理必须考虑健康的所有决定因素。首先，填补欧洲层面的知识空白：对全国性数据库进行跨国分析，以更好地了解全因死亡率和特定原因死亡率（如 Paljärvi 等人的研究报告1 所述），以及医疗保健的使用模式及其对严重精神障碍患者健康结果的影响。这包括解决缺乏对纵向医疗保健利用模式分析的问题，利用多维轨迹分析13，将身体和精神护理结合起来，从彼此的成功和失败中吸取经验教训。其次，根据文献和当地经验，对所有的综合护理模式进行最新审查，包括其组成部分、环境和可用证据类型。应特别关注新技术和综合护理模式的可持续性/环境影响。 14 第二步的目的是确定在每种模式下取得最大效果的关键因素，并在医疗保健人员有限的情况下确定最佳的组织方式。15 第三步，应对超越效率和单纯重组的政治挑战。这涉及到对相关组织和行动者的角色、地位和权力的质疑。例如，在法国，执业护士和非专业工作者的存在并不总是被医生所接受，社区医疗的作用也没有得到所有利益相关者的广泛认可。综合医疗模式是否应建立在初级医疗和/或专科心理健康医疗的基础上，这个问题也是造成紧张关系的一个重要原因。由德尔菲小组（包括患者、护理人员、医疗保健专业人员和政策制定者）就哪些综合护理模式最容易接受、最有前景达成欧洲共识是至关重要的。第四，达成这一共识应导致解决对这些新模式的成功至关重要的关键因素的融资问题，如预防、解决健康的社会驱动因素、协调的关键作用、开发强大的信息系统以及社区支持等。这包括社会知识、态度、实践、支付意愿以及实施综合医疗模式的财务影响。这些研究结果将告知主要的利益相关者，欧洲公民已经意识到 SMI 患者死亡率过高和面临不公正待遇的问题，在欧洲范围内推广综合模式是可行的，也很可能会得到公众的支持。最后，研究还应该深入探讨综合护理模式在现实环境中的实用性和可持续性，遵循精神健康实施研究转型的建议，提供更多可操作的证据，以缩小精神健康实施方面的差距。通过这种综合的方法，我们可以为患有 SMI 和躯体疾病的人提供更有效的、以人为本的护理。在实现这一目标的过程中，患者、医疗保健专业人员、政策制定者和欧洲各国公民的合作至关重要。

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引用次数: 0

Bidirectional associations between perinatal allopregnanolone and depression severity with postpartum gray matter volume in adult women 成年女性围产期异丙孕酮和抑郁严重程度与产后灰质体积之间的双向关系。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-06-24 DOI: 10.1111/acps.13723

Megan M. Hare, Anita Barber, Scott A. Shaffer, Kristina M. Deligiannidis

Background

Perinatal depression (PND) is a debilitating condition affecting maternal well-being and child development. Allopregnanolone (ALLO) is important to perinatal neuroplasticity, however its relationship with depression severity and postpartum structural brain volume is unknown.

Method

We examined perinatal temporal dynamics and bidirectional associations between ALLO and depression severity and the association between these variables and postpartum gray matter volume, using a random intercept cross-lagged panel model.

Results

We identified a unidirectional predictive relationship between PND severity and ALLO concentration, suggesting greater depression severity early in the perinatal period may contribute to subsequent changes in ALLO concentration (β = 0.26, p = 0.009), while variations in ALLO levels during the perinatal period influences the development and severity of depressive symptoms later in the postpartum period (β = 0.38, p = 0.007). Antepartum depression severity (Visit 2, β = 0.35, p = 0.004), ALLO concentration (Visit 2, β = 0.37, p = 0.001), and postpartum depression severity (Visit 3, β = 0.39, p = 0.031), each predicted the right anterior cingulate volume. Antepartum ALLO concentration (Visit 2, β = 0.29, p = 0.001) predicted left suborbital sulcus volume. Antepartum depression severity (Visit 1, β = 0.39, p = 0.006 and Visit 2, β = 0.48, p < 0.001) predicted the right straight gyrus volume. Postpartum depression severity (Visit 3, β = 0.36, p = 0.001) predicted left middle-posterior cingulate volume.

Conclusion

These results provide the first evidence of bidirectional associations between perinatal ALLO and depression severity with postpartum gray matter volume.

背景：围产期抑郁症（PND）是一种影响产妇福祉和儿童发育的致残性疾病。异孕酮（ALLO）对围产期神经可塑性非常重要，但其与抑郁症严重程度和产后脑结构体积的关系尚不清楚：我们使用随机截距交叉滞后面板模型研究了围产期的时间动态和 ALLO 与抑郁严重程度之间的双向关联，以及这些变量与产后灰质体积之间的关联：我们发现，PND严重程度与ALLO浓度之间存在单向预测关系，这表明围产期早期抑郁严重程度越高，ALLO浓度的后续变化越大（β = 0.26，p = 0.009），而围产期ALLO水平的变化会影响产后抑郁症状的发展和严重程度（β = 0.38，p = 0.007）。产前抑郁严重程度（第 2 次检查，β = 0.35，p = 0.004）、ALLO 浓度（第 2 次检查，β = 0.37，p = 0.001）和产后抑郁严重程度（第 3 次检查，β = 0.39，p = 0.031）均可预测右前扣带回体积。产前 ALLO 浓度（访问 2，β = 0.29，p = 0.001）可预测左眶下沟体积。产前抑郁严重程度（访问 1，β = 0.39，p = 0.006；访问 2，β = 0.48，p 结论：产前抑郁严重程度与左侧眶下沟体积有关：这些结果首次证明了围产期 ALLO 和抑郁严重程度与产后灰质体积之间的双向联系。

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引用次数: 0

Antidepressant-associated diagnostic change from major depressive to bipolar disorder 从重度抑郁症到双相情感障碍的抗抑郁相关诊断变化。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2024-06-24 DOI: 10.1111/acps.13721

Leonardo Tondo, Alessandro Miola, Marco Pinna, Martina Contu, Ross J. Baldessarini

Background

Anticipating diagnostic change from major depressive (MDD) to bipolar disorder (BD) can support better prognosis and treatment, especially of depression but is challenging and reported research results are inconsistent. We therefore assessed clinical characteristics associated with diagnostic change from MDD to BD with antidepressant treatments.

Methods

We compared characteristics of 3212 initially MDD patients who became (hypo)manic during antidepressant treatment to those with stable MDD diagnoses as well as with cases of stable, spontaneous BD, using standard bivariate and multivariate statistics.

Results

Among MDD patients, 6.69% [CI: 5.85–7.61] changed to BD, mostly type II (BD2, 76.7%). BD-converters had higher rates of familial mood disorders (74.1% vs. 57.1%) or BD (33.7% vs. 21.0%) and 2.8-years younger onset than stable MDD patients. They also had more prior depressive recurrences/year, years-of-illness, mood-stabilizer treatment, divorces, fewer children, more suicide attempts and drug-abuse, and higher intake cyclothymia, YMRS and MDQ scores. Predictors independently associated with diagnostic conversion were: more familial BD, depressions/year, unemployment, cyclothymic temperament, suicidal ideation or acts, and fewer children. BD-converters vs. spontaneous BD cases had significantly more suicide attempts, BD2 diagnoses, and affected relatives. Converting to vs. spontaneous BD1 was associated with more ADHD, more suicidal ideation or behavior, MDI course, and younger onset; converting to vs. spontaneous BD2 had more episodes/year, unemployment, ADHD, substance abuse, suicidal ideation or attempts, and more relatives with BD.

Conclusions

Few (6.69%) initially MDD subjects converted to BD, most (76.7%) to BD2. Independent predictive associations with diagnostic change included: familial BD, more depressions/year, unemployment, cyclothymic temperament, suicidal behavior and fewer children. Notably, several characteristics were stronger among those changing to BD during antidepressant treatment vs. others with spontaneous BD.

背景：预测从重度抑郁（MDD）到双相情感障碍（BD）的诊断变化有助于更好地预后和治疗，尤其是抑郁症的治疗，但这具有挑战性，而且报告的研究结果也不一致。因此，我们评估了与抗抑郁治疗后从重度抑郁症诊断为双相情感障碍相关的临床特征：我们采用标准的双变量和多变量统计方法，比较了 3212 例最初诊断为 MDD 但在抗抑郁治疗期间转为（低）躁狂的患者与诊断为 MDD 但病情稳定的患者以及病情稳定、自发转为 BD 的病例的特征：在 MDD 患者中，有 6.69% [CI：5.85-7.61] 转为 BD，其中大部分为 II 型（BD2，76.7%）。与稳定型 MDD 患者相比，BD 转换者的家族性情绪障碍（74.1% 对 57.1%）或 BD（33.7% 对 21.0%）发生率更高，发病年龄更小 2.8 岁。他们的抑郁复发次数/年、患病年数、情绪稳定剂治疗次数、离婚次数、子女人数、自杀未遂次数和药物滥用次数也更多，而且摄入的环状嗜铬细胞瘤、YMRS和MDQ评分也更高。与诊断转换独立相关的预测因素有：更多的家族性 BD、抑郁/年、失业、周期性气质、自杀意念或行为以及子女较少。与自发性 BD 病例相比，BD 转换者的自杀企图、BD2 诊断和受影响亲属的人数明显更多。转为BD1与自发BD1的患者有更多的ADHD、更多的自杀意念或行为、MDI病程以及更年轻的发病年龄；转为BD2与自发BD2的患者有更多的发作/年、失业、ADHD、药物滥用、自杀意念或企图以及更多的亲属患有BD：很少（6.69%）最初为 MDD 的受试者转为 BD，大多数（76.7%）转为 BD2。与诊断改变相关的独立预测因素包括：家族性 BD、每年抑郁次数较多、失业、周期性气质、自杀行为和子女较少。值得注意的是，与其他自发性 BD 患者相比，在抗抑郁治疗期间转为 BD 患者的几个特征更为明显。

{"title":"Antidepressant-associated diagnostic change from major depressive to bipolar disorder","authors":"Leonardo Tondo, Alessandro Miola, Marco Pinna, Martina Contu, Ross J. Baldessarini","doi":"10.1111/acps.13721","DOIUrl":"10.1111/acps.13721","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anticipating diagnostic change from major depressive (MDD) to bipolar disorder (BD) can support better prognosis and treatment, especially of depression but is challenging and reported research results are inconsistent. We therefore assessed clinical characteristics associated with diagnostic change from MDD to BD with antidepressant treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared characteristics of 3212 initially MDD patients who became (hypo)manic during antidepressant treatment to those with stable MDD diagnoses as well as with cases of stable, spontaneous BD, using standard bivariate and multivariate statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among MDD patients, 6.69% [CI: 5.85–7.61] changed to BD, mostly type II (BD2, 76.7%). BD-converters had higher rates of familial mood disorders (74.1% vs. 57.1%) or BD (33.7% vs. 21.0%) and 2.8-years younger onset than stable MDD patients. They also had more prior depressive recurrences/year, years-of-illness, mood-stabilizer treatment, divorces, fewer children, more suicide attempts and drug-abuse, and higher intake cyclothymia, YMRS and MDQ scores. Predictors independently associated with diagnostic conversion were: more familial BD, depressions/year, unemployment, cyclothymic temperament, suicidal ideation or acts, and fewer children. BD-converters vs. spontaneous BD cases had significantly more suicide attempts, BD2 diagnoses, and affected relatives. Converting to vs. spontaneous BD1 was associated with more ADHD, more suicidal ideation or behavior, MDI course, and younger onset; converting to vs. spontaneous BD2 had more episodes/year, unemployment, ADHD, substance abuse, suicidal ideation or attempts, and more relatives with BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Few (6.69%) initially MDD subjects converted to BD, most (76.7%) to BD2. Independent predictive associations with diagnostic change included: familial BD, more depressions/year, unemployment, cyclothymic temperament, suicidal behavior and fewer children. Notably, several characteristics were stronger among those changing to BD during antidepressant treatment vs. others with spontaneous BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"126-137"},"PeriodicalIF":5.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453794","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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