George Kirov, Emily Simmonds, Tyler Kaster, Valentina Escott-Price
Background
Electroconvulsive therapy (ECT) is the most effective therapy for severe or treatment-resistant depression. A common short-term side effect is memory problems, and it is important to know whether ECT increases the risk for dementia later in life. Major psychiatric disorders are associated with an increased risk for developing dementia, making the analysis of dementia risk challenging. A small number of previous studies indicate that ECT does not increase this risk. We wanted to examine the association between ECT and subsequent risk of dementia in the population of Wales, UK.
Methods
We analysed the electronic health records of the Welsh population. We selected 110,774 people aged between 35 and 65 on 1.1.1995 who had no prior diagnosis of dementia and had been hospitalised with diagnoses of affective disorders. Of those, 1010 received at least one course of ECT between 1995 and 2024 before a diagnosis of dementia.
Results
The 110,774 persons were followed up until the end of the study period in 2024, or the date of dementia diagnosis, or the date of death, for a mean of 24.5 (SD = 6.3) years. 15.4% of the ECT group developed dementia, compared to 13.1% for the non-ECT-treated individuals. After controlling for age, sex, social deprivation status, physical comorbidities, history of alcohol abuse, the number of psychiatric hospitalisations and the age when they first occurred, the hazard ratio for dementia was not increased in the ECT group: HR = 0.888, 95% CI: 0.757–1.044, p = 0.15.
Conclusions
Though crude analyses found a greater risk of dementia among those receiving ECT, once confounders were accounted for, we failed to find a statistically significant risk for dementia among those who received ECT. Our findings strengthen the conclusions of previous reports and provide further reassurance for people considering this treatment.
{"title":"Risk of Dementia After Electroconvulsive Therapy: A Cohort Study on the Population of Wales","authors":"George Kirov, Emily Simmonds, Tyler Kaster, Valentina Escott-Price","doi":"10.1111/acps.70005","DOIUrl":"https://doi.org/10.1111/acps.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electroconvulsive therapy (ECT) is the most effective therapy for severe or treatment-resistant depression. A common short-term side effect is memory problems, and it is important to know whether ECT increases the risk for dementia later in life. Major psychiatric disorders are associated with an increased risk for developing dementia, making the analysis of dementia risk challenging. A small number of previous studies indicate that ECT does not increase this risk. We wanted to examine the association between ECT and subsequent risk of dementia in the population of Wales, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed the electronic health records of the Welsh population. We selected 110,774 people aged between 35 and 65 on 1.1.1995 who had no prior diagnosis of dementia and had been hospitalised with diagnoses of affective disorders. Of those, 1010 received at least one course of ECT between 1995 and 2024 before a diagnosis of dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 110,774 persons were followed up until the end of the study period in 2024, or the date of dementia diagnosis, or the date of death, for a mean of 24.5 (SD = 6.3) years. 15.4% of the ECT group developed dementia, compared to 13.1% for the non-ECT-treated individuals. After controlling for age, sex, social deprivation status, physical comorbidities, history of alcohol abuse, the number of psychiatric hospitalisations and the age when they first occurred, the hazard ratio for dementia was not increased in the ECT group: HR = 0.888, 95% CI: 0.757–1.044, <i>p</i> = 0.15.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though crude analyses found a greater risk of dementia among those receiving ECT, once confounders were accounted for, we failed to find a statistically significant risk for dementia among those who received ECT. Our findings strengthen the conclusions of previous reports and provide further reassurance for people considering this treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"270-277"},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930077","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}
Jasmien Obbels, Kristof Vansteelandt, Esmée Verwijk, Kaat Hebbrecht, Shauni Verspecht, Nathalie Denayer, Liese Van den Eynde, Pascal Sienaert
Objective
There is ongoing concern about the possible negative impact of ECT on neuropsychological functioning, especially on autobiographical memory. In this study we aimed to identify the short- and long-term neuropsychological effects of ECT in the domain of memory.
Methods
Twenty-eight patients aged 18 years and older with a unipolar or bipolar depression, referred for ECT, were eventually included. The neuropsychological test battery assessed verbal memory, verbal fluency, and autobiographical memory. The battery was administered prior to ECT, 1 week, and 3 months after the last ECT session. We compared the neuropsychological performances of our sample with normative data from a healthy population.
Results
After adjusting for covariates, performance on tasks assessing verbal memory, verbal fluency, and autobiographical memory showed a significant decline during ECT. However, test scores significantly improved following the completion of ECT. Additionally, patients with higher QIDS-CR scores consistently demonstrated lower performance on the verbal fluency task across all time points. No significant association was found between the total number of ECT sessions and changes in test scores during or after treatment. 3 months after ending ECT, cognitive functioning returned to pretreatment levels of performance. We found that patients with a depressive episode performed significantly worse on task measuring verbal memory and fluency at every time point as compared to a healthy population.
Conclusion
Our results show that a course of ECT in patients with a depressive episode influences verbal memory, autobiographical memory and verbal fluency. Neuropsychological performances significantly declined during ECT. Following ECT, neuropsychological performances, as compared to during ECT, were significantly improved and were equivalent to baseline. However, neuropsychological performance remains poor as compared to a healthy population.
{"title":"Exploring Neuropsychological Functioning After Electroconvulsive Therapy in the Domain of Memory: A Prospective Study","authors":"Jasmien Obbels, Kristof Vansteelandt, Esmée Verwijk, Kaat Hebbrecht, Shauni Verspecht, Nathalie Denayer, Liese Van den Eynde, Pascal Sienaert","doi":"10.1111/acps.70001","DOIUrl":"https://doi.org/10.1111/acps.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is ongoing concern about the possible negative impact of ECT on neuropsychological functioning, especially on autobiographical memory. In this study we aimed to identify the short- and long-term neuropsychological effects of ECT in the domain of memory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-eight patients aged 18 years and older with a unipolar or bipolar depression, referred for ECT, were eventually included. The neuropsychological test battery assessed verbal memory, verbal fluency, and autobiographical memory. The battery was administered prior to ECT, 1 week, and 3 months after the last ECT session. We compared the neuropsychological performances of our sample with normative data from a healthy population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for covariates, performance on tasks assessing verbal memory, verbal fluency, and autobiographical memory showed a significant decline during ECT. However, test scores significantly improved following the completion of ECT. Additionally, patients with higher QIDS-CR scores consistently demonstrated lower performance on the verbal fluency task across all time points. No significant association was found between the total number of ECT sessions and changes in test scores during or after treatment. 3 months after ending ECT, cognitive functioning returned to pretreatment levels of performance. We found that patients with a depressive episode performed significantly worse on task measuring verbal memory and fluency at every time point as compared to a healthy population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results show that a course of ECT in patients with a depressive episode influences verbal memory, autobiographical memory and verbal fluency. Neuropsychological performances significantly declined during ECT. Following ECT, neuropsychological performances, as compared to during ECT, were significantly improved and were equivalent to baseline. However, neuropsychological performance remains poor as compared to a healthy population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"260-269"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929995","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}
Mete Ercis, Alessandro Miola, Javier Ortiz-Orendain, Vanessa K. Pazdernik, Tamahara Gonzalez-Campos, Manuel Gardea-Resendez, Peggy M. Gruhlke, Ian M. Michel, Jennifer L. Vande Voort, Alastair J. McKean, Aysegul Ozerdem, Mark A. Frye
Background
Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.
Methods
Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.
Results
A total of 202 individuals (BD n = 73, SZ n = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (p = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, p < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (p < 0.001).
Conclusion
This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.
{"title":"Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology","authors":"Mete Ercis, Alessandro Miola, Javier Ortiz-Orendain, Vanessa K. Pazdernik, Tamahara Gonzalez-Campos, Manuel Gardea-Resendez, Peggy M. Gruhlke, Ian M. Michel, Jennifer L. Vande Voort, Alastair J. McKean, Aysegul Ozerdem, Mark A. Frye","doi":"10.1111/acps.13826","DOIUrl":"https://doi.org/10.1111/acps.13826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 202 individuals (BD <i>n</i> = 73, SZ <i>n</i> = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (<i>p</i> = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, <i>p</i> < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"278-289"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929838","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}
David R A Coelho, Jennifer Nicoloro Santabarbara, Marzieh Majd, Willians Fernando Vieira, Maura De Laney, Melis Lydston, Olindo Assis Martins-Filho, Lilian Maria Garcia Bahia-Oliveira, Joshua D Salvi, Paolo Cassano, Katherine E Burdick
Introduction: Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD.
Methods: We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non-English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non-Randomized Studies-of Exposure (ROBINS-E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre-registered in PROSPERO (CRD42023415437).
Results: Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross-sectional designs, which limit causal interpretations.
Conclusion: This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF-α, IL-6, and IL-1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti-inflammatory strategies to support cognitive health in individuals with BD.
双相情感障碍（BD）常与认知功能障碍相关，认知功能障碍可显著影响患者的生活质量和功能恢复。越来越多的证据表明，炎症可能导致认知功能障碍。我们按照PRISMA指南，于2023年3月23日检索了6个数据库（PubMed、Embase、Cochrane Library、Web of Science、PsycINFO和ClinicalTrials.gov），进行了系统综述，目的是确定外周或中枢炎症标志物与成年双相障碍患者认知功能之间关系的研究。排除了涉及动物、摘要、方案、综述和非英文出版物的研究。纳入研究的质量采用非随机暴露研究的偏倚风险（ROBINS-E）进行评估。基于炎症标志物和BD认知领域之间的关联，我们完成了一项叙述性综合研究，并对结果进行了分层。该综述方案在PROSPERO （CRD42023415437）中进行了预注册。结果：在2680份已确定的记录中，25项研究涉及3567名成年双相障碍患者(平均年龄：43.6岁；1839名女性和1728名男性)符合纳入标准。17项研究被归类为低风险偏倚，7项研究存在一些问题，1项研究被归类为高风险。c反应蛋白（CRP）、肿瘤坏死因子-α (TNF-α)、白细胞介素-6 （IL-6）和白细胞介素-1受体拮抗剂（IL-1Ra）水平升高与执行功能、处理速度和记忆等领域的认知功能障碍最常相关。其他炎症标志物的结果不太一致。大多数研究依赖于横截面设计，这限制了因果解释。结论：本综述发现炎症与双相障碍患者认知功能障碍之间存在一致的关联，特别是涉及CRP、TNF-α、IL-6和IL-1RA等领域的执行功能、处理速度和记忆。靶向炎症可能为减轻这些认知挑战提供了一种有希望的方法。未来的研究应优先考虑纵向设计，标准化的认知评估，并探索中枢炎症标志物，以更好地了解双相障碍认知功能障碍的神经生物学过程。这些发现可能有助于制定辅助抗炎策略，以支持双相障碍患者的认知健康。
{"title":"Association Between Inflammatory Markers and Cognitive Function in Adults With Bipolar Disorder: A Systematic Review.","authors":"David R A Coelho, Jennifer Nicoloro Santabarbara, Marzieh Majd, Willians Fernando Vieira, Maura De Laney, Melis Lydston, Olindo Assis Martins-Filho, Lilian Maria Garcia Bahia-Oliveira, Joshua D Salvi, Paolo Cassano, Katherine E Burdick","doi":"10.1111/acps.13824","DOIUrl":"https://doi.org/10.1111/acps.13824","url":null,"abstract":"<p><strong>Introduction: </strong>Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD.</p><p><strong>Methods: </strong>We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non-English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non-Randomized Studies-of Exposure (ROBINS-E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre-registered in PROSPERO (CRD42023415437).</p><p><strong>Results: </strong>Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross-sectional designs, which limit causal interpretations.</p><p><strong>Conclusion: </strong>This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF-α, IL-6, and IL-1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti-inflammatory strategies to support cognitive health in individuals with BD.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688430","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":"Immortal Time Bias, Confounding by Indication, and Antidepressant Pooling","authors":"Itsuki Terao","doi":"10.1111/acps.13827","DOIUrl":"10.1111/acps.13827","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"318-319"},"PeriodicalIF":5.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726065","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}
Increasing evidence has highlighted bidirectional associations between mental disorders and general medical conditions, with underlying causes ranging from lifestyle habits and side effects from medications to genetic contributions. Novel methods now provide a way to estimate the shared genetic underpinnings and the possibility of a causal relationship between conditions.
Methods
Using summary statistics from large genome-wide association studies of 16 categories of general medical conditions and 12 categories of mental disorders, we estimated pairwise genetic correlations between general medical conditions and mental disorders using LD score regression. For conditions with significant, positive genetic correlations, we used the latent causal variable (LCV) model to assess the evidence for a causal relationship between them.
Results
Ninety-five out of 192 pairs of conditions were significantly genetically correlated (q ≤ 0.05). Strong and significant correlations were found between conditions such as infections and a psychiatric cross-disorder phenotype (rg = 0.50, p = 1.33 × 10−6) and irritable bowel syndrome and depression (rg = 0.58, p = 1.50 × 10−16). In the causality analyses, statistically significant evidence for causality was obtained for seven pairs of conditions, including infections being causal to the psychiatric cross-disorder phenotype, metabolic disorders being causal to attention deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) being causal to bone and cartilage disorders, arthropathies and epilepsy, obsessive–compulsive disorder (OCD) being causal to irritable bowel syndrome (IBS), and ADHD being causal to arthropathies.
Conclusions
Multiple pairs of general medical conditions and mental disorders were significantly genetically correlated, and for some pairs, there was genetic evidence for a causal relationship. Our findings can inform further molecular studies and clinical practice, raising awareness of the possible co-occurrence of these conditions.
越来越多的证据强调了精神障碍与一般医疗状况之间的双向关联，其潜在原因包括生活习惯和药物副作用以及遗传因素。新的方法现在提供了一种方法来估计共同的遗传基础和条件之间因果关系的可能性。方法利用16类一般疾病和12类精神障碍的大型全基因组关联研究的汇总统计数据，利用LD评分回归估计一般疾病和精神障碍之间的两两遗传相关性。对于具有显著正遗传相关性的条件，我们使用潜在因果变量（LCV）模型来评估它们之间因果关系的证据。结果192对条件中95对遗传相关显著（q≤0.05）。感染和精神交叉障碍表型（rg = 0.50, p = 1.33 × 10−6）与肠易激综合征和抑郁症（rg = 0.58, p = 1.50 × 10−16）之间存在强烈且显著的相关性。在因果分析中，获得了7对条件的因果关系的统计显著证据，包括感染是精神交叉障碍表型的因果关系，代谢障碍是注意缺陷/多动障碍（ADHD）的因果关系，创伤后应激障碍（PTSD）是骨骼和软骨疾病的因果关系，关节病和癫痫，强迫症（OCD）是肠易激综合征（IBS）的因果关系，以及多动症与关节病的关系结论多对一般疾病与精神障碍存在显著的遗传相关，部分对存在因果关系的遗传证据。我们的发现可以为进一步的分子研究和临床实践提供信息，提高人们对这些疾病可能同时发生的认识。
{"title":"Systematic Multi-Trait Study of Genetic Correlation and Causality Relationships Between General Medical Conditions and Mental Disorders","authors":"Ron Nudel, Maria Da Re, Michael E. Benros","doi":"10.1111/acps.13825","DOIUrl":"https://doi.org/10.1111/acps.13825","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Increasing evidence has highlighted bidirectional associations between mental disorders and general medical conditions, with underlying causes ranging from lifestyle habits and side effects from medications to genetic contributions. Novel methods now provide a way to estimate the shared genetic underpinnings and the possibility of a causal relationship between conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using summary statistics from large genome-wide association studies of 16 categories of general medical conditions and 12 categories of mental disorders, we estimated pairwise genetic correlations between general medical conditions and mental disorders using LD score regression. For conditions with significant, positive genetic correlations, we used the latent causal variable (LCV) model to assess the evidence for a causal relationship between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-five out of 192 pairs of conditions were significantly genetically correlated (<i>q</i> ≤ 0.05). Strong and significant correlations were found between conditions such as infections and a psychiatric cross-disorder phenotype (<i>r</i><sub>g</sub> = 0.50, <i>p</i> = 1.33 × 10<sup>−6</sup>) and irritable bowel syndrome and depression (<i>r</i><sub>g</sub> = 0.58, <i>p</i> = 1.50 × 10<sup>−16</sup>). In the causality analyses, statistically significant evidence for causality was obtained for seven pairs of conditions, including infections being causal to the psychiatric cross-disorder phenotype, metabolic disorders being causal to attention deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) being causal to bone and cartilage disorders, arthropathies and epilepsy, obsessive–compulsive disorder (OCD) being causal to irritable bowel syndrome (IBS), and ADHD being causal to arthropathies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple pairs of general medical conditions and mental disorders were significantly genetically correlated, and for some pairs, there was genetic evidence for a causal relationship. Our findings can inform further molecular studies and clinical practice, raising awareness of the possible co-occurrence of these conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"236-249"},"PeriodicalIF":5.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768048","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}
Manuel Sevilla-Ramos, Valentina Ladera, Ricardo García-García, Rosa Ayesa-Arriola
Introduction
Motor dexterity deficits have been observed both before and during first-episode psychosis (FEP), suggesting this may be a potential endophenotype for schizophrenia spectrum disorders. We aimed to compare motor dexterity performance in FEP patients, their first-degree relatives, and controls. We also investigated whether sociodemographic, premorbid, clinical, and cognitive factors contribute to motor dexterity.
Methods
The sample included 133 FEP patients, 244 of their first-degree relatives (146 parents, 98 siblings), and 202 controls. Motor dexterity was assessed using the Grooved Pegboard Test as part of a neuropsychological battery assessing verbal and visual memory, processing speed, working memory, executive function, attention, and theory of mind. Raw scores were converted to Z-scores. Intelligence quotient and global cognitive function were estimated. Group comparisons were made using analysis of covariance with post hoc tests. Age, sex, and years of education were included as covariates. Multiple linear regression models examined associations between motor dexterity and other variables within each group.
Results
There was a significant group difference on the Grooved Pegboard Test (F = 16.25, p < 0.001). FEP patients (M = −1.26) and their parents (M = −1.14) scored lowest, while siblings (M = −0.30) and controls (M = −0.22) scored highest. The FEP group also scored lowest on other cognitive tests (p < 0.001). A positive association between global cognitive function and Grooved Pegboard performance was found in all groups (β = 0.47–0.84, p < 0.001). Group-specific associations with age, sex, education, intelligence, executive function, attention, and processing speed were also observed (p < 0.05).
Conclusions
Motor dexterity deficits were observed in FEP patients and their parents, which may reflect underlying genetic liability or result from the disorder itself. The preserved motor dexterity in unaffected siblings challenges a strict endophenotypic interpretation and suggests a potential protective effect. Motor dexterity deficits were associated with broader cognitive impairment, intelligence quotient, attention, processing speed, and executive function.
{"title":"Motor Dexterity Deficits in Individuals With First-Episode Psychosis and Their First-Degree Relatives","authors":"Manuel Sevilla-Ramos, Valentina Ladera, Ricardo García-García, Rosa Ayesa-Arriola","doi":"10.1111/acps.13821","DOIUrl":"https://doi.org/10.1111/acps.13821","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Motor dexterity deficits have been observed both before and during first-episode psychosis (FEP), suggesting this may be a potential endophenotype for schizophrenia spectrum disorders. We aimed to compare motor dexterity performance in FEP patients, their first-degree relatives, and controls. We also investigated whether sociodemographic, premorbid, clinical, and cognitive factors contribute to motor dexterity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample included 133 FEP patients, 244 of their first-degree relatives (146 parents, 98 siblings), and 202 controls. Motor dexterity was assessed using the Grooved Pegboard Test as part of a neuropsychological battery assessing verbal and visual memory, processing speed, working memory, executive function, attention, and theory of mind. Raw scores were converted to <i>Z</i>-scores. Intelligence quotient and global cognitive function were estimated. Group comparisons were made using analysis of covariance with post hoc tests. Age, sex, and years of education were included as covariates. Multiple linear regression models examined associations between motor dexterity and other variables within each group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a significant group difference on the Grooved Pegboard Test (<i>F</i> = 16.25, <i>p</i> < 0.001). FEP patients (M = −1.26) and their parents (M = −1.14) scored lowest, while siblings (M = −0.30) and controls (M = −0.22) scored highest. The FEP group also scored lowest on other cognitive tests (<i>p</i> < 0.001). A positive association between global cognitive function and Grooved Pegboard performance was found in all groups (<i>β</i> = 0.47–0.84, <i>p</i> < 0.001). Group-specific associations with age, sex, education, intelligence, executive function, attention, and processing speed were also observed (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Motor dexterity deficits were observed in FEP patients and their parents, which may reflect underlying genetic liability or result from the disorder itself. The preserved motor dexterity in unaffected siblings challenges a strict endophenotypic interpretation and suggests a potential protective effect. Motor dexterity deficits were associated with broader cognitive impairment, intelligence quotient, attention, processing speed, and executive function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"216-227"},"PeriodicalIF":5.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768049","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":"Expanding the Utilization of Pharmacological Treatments for Alcohol Use Disorder: Reflections on a Swedish Nationwide Study","authors":"Szu-Chieh Chiu, Lien-Chung Wei","doi":"10.1111/acps.13823","DOIUrl":"https://doi.org/10.1111/acps.13823","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"250-251"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767935","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}
Paul A. Vöhringer, Sergio A. Barroilhet, Bárbara A. Palma, Roy H. Perlis
Objective
Antidepressants remain among the most widely used class of drugs in treating bipolar disorder, despite their minimal efficacy in randomized clinical trials and concern for association with manic episodes. This study sought to evaluate the outcomes of antidepressant treatment in bipolar depression in a large naturalistic cohort study, STEP-BD, in terms of symptomatic remission as well as emergence of mania, using a propensity score (PS) analysis to reduce indication bias.
Methods
Propensity scores were developed to estimate the probability of antidepressant exposure using multivariate logistic regression models; these scores were then used to match antidepressant-exposed and non-exposed individuals. Cox regression models were used to estimate hazard ratios for manic switch and time to remission, adjusted for these scores in the matched population.
Results
Total sample included 2166 individuals, of whom 1085 were exposed to AD and 1081 were unexposed to AD; mean follow-up duration was 182.5 (SD: 44.6) days (median = 126, ICR: 87.4). Cox regression models for manic switch with antidepressant exposure versus non-exposure yielded an unadjusted hazard ratio (HR) of 0.93 (95% CI 0.67–1.14) and PS-adjusted HR of 0.77 (95% CI 0.51–1.08), neither of which was statistically significantly different from 1. Probability of symptomatic remission was also not significantly associated with antidepressant exposure, with unadjusted and PS-adjusted HR of 1.15 (95% CI 0.97–1.37) and 1.02 (95% CI 0.87–1.23), respectively.
Conclusion
With PS adjustment, there was no evidence of increased likelihood of manic switch or achievement of symptomatic remission associated with antidepressant use in bipolar depression. Our results underscore the ongoing need to identify alternative strategies for effective treatment of bipolar depression.
目的抗抑郁药仍然是治疗双相情感障碍最广泛使用的一类药物，尽管它们在随机临床试验中的疗效很小，并且与躁狂发作有关。本研究试图在一项大型自然队列研究STEP-BD中评估抗抑郁药治疗双相抑郁症的结果，在症状缓解和躁狂出现方面，使用倾向评分（PS）分析来减少指征偏倚。方法采用多变量logistic回归模型建立倾向评分，估计抗抑郁药物暴露的概率；然后用这些分数来匹配暴露于抗抑郁药物和未暴露于抗抑郁药物的个体。Cox回归模型用于估计躁狂转换和缓解时间的风险比，并根据匹配人群的这些评分进行调整。结果共纳入2166人，其中暴露于AD的1085人，未暴露于AD的1081人；平均随访时间为182.5 （SD: 44.6）天（中位数= 126,ICR: 87.4）。抗抑郁药暴露组与非抗抑郁药暴露组躁狂转换的Cox回归模型显示，未经调整的风险比（HR）为0.93 (95% CI 0.67-1.14)，经ps调整的风险比（HR）为0.77 (95% CI 0.51-1.08)，两者均与1无统计学差异。症状缓解的概率也与抗抑郁药暴露无显著相关，未调整和ps调整的HR分别为1.15 （95% CI 0.97-1.37）和1.02 （95% CI 0.87-1.23）。结论：经PS调整后，没有证据表明双相抑郁症患者使用抗抑郁药后躁狂转换或症状缓解的可能性增加。我们的研究结果强调了确定有效治疗双相抑郁症的替代策略的持续需要。
{"title":"Antidepressant Remission and Manic Switch in Bipolar Depression: A Propensity Score Analysis","authors":"Paul A. Vöhringer, Sergio A. Barroilhet, Bárbara A. Palma, Roy H. Perlis","doi":"10.1111/acps.13822","DOIUrl":"https://doi.org/10.1111/acps.13822","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Antidepressants remain among the most widely used class of drugs in treating bipolar disorder, despite their minimal efficacy in randomized clinical trials and concern for association with manic episodes. This study sought to evaluate the outcomes of antidepressant treatment in bipolar depression in a large naturalistic cohort study, STEP-BD, in terms of symptomatic remission as well as emergence of mania, using a propensity score (PS) analysis to reduce indication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Propensity scores were developed to estimate the probability of antidepressant exposure using multivariate logistic regression models; these scores were then used to match antidepressant-exposed and non-exposed individuals. Cox regression models were used to estimate hazard ratios for manic switch and time to remission, adjusted for these scores in the matched population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total sample included 2166 individuals, of whom 1085 were exposed to AD and 1081 were unexposed to AD; mean follow-up duration was 182.5 (SD: 44.6) days (median = 126, ICR: 87.4). Cox regression models for manic switch with antidepressant exposure versus non-exposure yielded an unadjusted hazard ratio (HR) of 0.93 (95% CI 0.67–1.14) and PS-adjusted HR of 0.77 (95% CI 0.51–1.08), neither of which was statistically significantly different from 1. Probability of symptomatic remission was also not significantly associated with antidepressant exposure, with unadjusted and PS-adjusted HR of 1.15 (95% CI 0.97–1.37) and 1.02 (95% CI 0.87–1.23), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With PS adjustment, there was no evidence of increased likelihood of manic switch or achievement of symptomatic remission associated with antidepressant use in bipolar depression. Our results underscore the ongoing need to identify alternative strategies for effective treatment of bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"228-235"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768092","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}
Demitri F. Papolos, Martin H. Teicher, Robert M. Post
Introduction
Bipolar disorder (BD), characterized by extreme mood shifts between mania and depression, can manifest in childhood, and pose treatment challenges. Treatment for full-criteria BD I or II in children has been partially described in the literature, but major uncertainties exist regarding non-classic presentations, which were originally designated as bipolar “not otherwise specified” (BP-NOS) in DSM-IV and in DSM-5 and ICD-11 as either other specified or unspecified BD (S-USBD). This review aims to provide literature-based recommendations on the treatment of S-USBD, with a focus on a fear of harm (FOH) subtype, now termed temperature and sleep dysregulation disorder (TSDD).
Methods
A broad systematic literature review with AI assistance was conducted to identify all articles in PubMed providing data on the treatment of children with either atypical BD, BD-NOS, USBD, specified BD, rapid cycling BD, or a phenotype of BD.
Aims
Given the paucity of pharmacological treatment literature on any of the earliest forms of BD prior to their achieving a BP I or BP II diagnosis, it was felt that there was a critical need to review the existent literature on the earliest presentations and prodromes, which now fall under the rubric of specified (BD S-USBD). Here, the focus is on the prevalent BP-NOS subtype, which meets all the classical presentations of BP except for the brief durations of mania, and a more newly recognized form of S-USBD called TSDD.
Results
Eleven family-focused psychotherapy studies were identified, including nine randomized controlled trials (RCTs) with uniformly positive results versus the comparative group, which was treatment as usual (TAU) for unclear subtypes and subtypes of S-USBD. Only three psychopharmacological RCTS were reported, and only one on aripiprazole in unspecified subtypes of S-USBD in high-risk children showed a significant difference from placebo. None of the controlled trials and only two case series provided separate outcome data on the S-USBD subtypes, except for one that focused exclusively on the TSDD subtype. These two case series reports preliminarily defined the TSDD subtype and provided novel pharmacological treatment data, including lithium, clonidine, and ketamine, which led to good outcomes.
{"title":"Treatment of Early-Onset Specified and Unspecified Bipolar Disorders: A Systematic Review and Strategies for Identifying and Managing a Thermally Dysregulated Subtype in Children","authors":"Demitri F. Papolos, Martin H. Teicher, Robert M. Post","doi":"10.1111/acps.13817","DOIUrl":"https://doi.org/10.1111/acps.13817","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD), characterized by extreme mood shifts between mania and depression, can manifest in childhood, and pose treatment challenges. Treatment for full-criteria BD I or II in children has been partially described in the literature, but major uncertainties exist regarding non-classic presentations, which were originally designated as bipolar “not otherwise specified” (BP-NOS) in DSM-IV and in DSM-5 and ICD-11 as either other specified or unspecified BD (S-USBD). This review aims to provide literature-based recommendations on the treatment of S-USBD, with a focus on a fear of harm (FOH) subtype, now termed temperature and sleep dysregulation disorder (TSDD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A broad systematic literature review with AI assistance was conducted to identify all articles in PubMed providing data on the treatment of children with either atypical BD, BD-NOS, USBD, specified BD, rapid cycling BD, or a phenotype of BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Given the paucity of pharmacological treatment literature on any of the earliest forms of BD prior to their achieving a BP I or BP II diagnosis, it was felt that there was a critical need to review the existent literature on the earliest presentations and prodromes, which now fall under the rubric of specified (BD S-USBD). Here, the focus is on the prevalent BP-NOS subtype, which meets all the classical presentations of BP except for the brief durations of mania, and a more newly recognized form of S-USBD called TSDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven family-focused psychotherapy studies were identified, including nine randomized controlled trials (RCTs) with uniformly positive results versus the comparative group, which was treatment as usual (TAU) for unclear subtypes and subtypes of S-USBD. Only three psychopharmacological RCTS were reported, and only one on aripiprazole in unspecified subtypes of S-USBD in high-risk children showed a significant difference from placebo. None of the controlled trials and only two case series provided separate outcome data on the S-USBD subtypes, except for one that focused exclusively on the TSDD subtype. These two case series reports preliminarily defined the TSDD subtype and provided novel pharmacological treatment data, including lithium, clonidine, and ketamine, which led to good outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Good support was pr","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"156-179"},"PeriodicalIF":5.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767502","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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