Acta Psychiatrica Scandinavica最新文献_第8页

Immortal Time Bias, Confounding by Indication, and Antidepressant Pooling 不朽的时间偏差、适应症混淆和抗抑郁药物池化。

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-26 DOI: 10.1111/acps.13827

Itsuki Terao

引用次数: 0

Systematic Multi-Trait Study of Genetic Correlation and Causality Relationships Between General Medical Conditions and Mental Disorders 一般疾病与精神障碍遗传相关及因果关系的系统多性状研究

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-25 DOI: 10.1111/acps.13825

Ron Nudel, Maria Da Re, Michael E. Benros

Introduction

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 (r_g = 0.50, p = 1.33 × 10⁻⁶) and irritable bowel syndrome and depression (r_g = 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。

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引用次数: 0

Motor Dexterity Deficits in Individuals With First-Episode Psychosis and Their First-Degree Relatives 首发精神病患者及其一级亲属的运动灵活性缺陷

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-25 DOI: 10.1111/acps.13821

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.

在首发精神病（FEP）之前和期间都观察到运动灵活性缺陷，这表明这可能是精神分裂症谱系障碍的潜在内表型。我们的目的是比较FEP患者、他们的一级亲属和对照组的运动灵活性表现。我们还调查了社会人口学、发病前、临床和认知因素是否有助于运动灵活性。方法133例FEP患者，其一级亲属244例（父母146例，兄弟姐妹98例），对照组202例。运动灵巧度的评估使用槽钉板测试作为神经心理学电池的一部分，评估语言和视觉记忆，处理速度，工作记忆，执行功能，注意力和心理理论。原始分数被转换成z分数。评估了智商和整体认知功能。采用协方差分析和事后检验进行组间比较。协变量包括年龄、性别和受教育年限。多元线性回归模型检验了每组中运动灵活性和其他变量之间的关系。结果凹槽钉板测试组间差异有统计学意义（F = 16.25, p < 0.001）。FEP患者（M = - 1.26）及其父母（M = - 1.14）得分最低，而兄弟姐妹（M = - 0.30）和对照组（M = - 0.22）得分最高。FEP组在其他认知测试中得分也最低（p < 0.001）。在所有组中，整体认知功能与凹槽钉板成绩呈正相关（β = 0.47-0.84, p < 0.001）。观察到年龄、性别、教育程度、智力、执行功能、注意力和处理速度与群体特异性相关（p < 0.05）。结论FEP患者及其父母存在运动灵巧性缺陷，这可能反映了潜在的遗传倾向或疾病本身的原因。在未受影响的兄弟姐妹中保留的运动灵活性挑战了严格的内表型解释，并提出了潜在的保护作用。运动灵活性缺陷与更广泛的认知障碍、智商、注意力、处理速度和执行功能有关。

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引用次数: 0

Expanding the Utilization of Pharmacological Treatments for Alcohol Use Disorder: Reflections on a Swedish Nationwide Study 扩大药物治疗酒精使用障碍的利用：对瑞典全国研究的反思

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-19 DOI: 10.1111/acps.13823

Szu-Chieh Chiu, Lien-Chung Wei

引用次数: 0

Antidepressant Remission and Manic Switch in Bipolar Depression: A Propensity Score Analysis 双相抑郁症的抗抑郁缓解和躁狂转换：倾向评分分析

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-14 DOI: 10.1111/acps.13822

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。

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引用次数: 0

Treatment of Early-Onset Specified and Unspecified Bipolar Disorders: A Systematic Review and Strategies for Identifying and Managing a Thermally Dysregulated Subtype in Children 早发特异性和非特异性双相情感障碍的治疗：识别和管理儿童热失调亚型的系统回顾和策略

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-13 DOI: 10.1111/acps.13817

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.

Conclusion

Good support was pr

双相情感障碍（BD）以躁狂症和抑郁症之间的极端情绪变化为特征，可在儿童时期表现出来，并给治疗带来挑战。文献中部分描述了儿童全标准双相障碍I或II的治疗方法，但主要不确定性存在于非经典表现，最初在DSM-IV、DSM-5和ICD-11中被指定为双相障碍“未另行指定”（BP-NOS），作为其他指定或未指定的双相障碍（S-USBD）。本综述旨在提供基于文献的S-USBD治疗建议，重点关注恐惧伤害（FOH）亚型，现在称为温度和睡眠调节障碍（TSDD）。方法在人工智能辅助下进行广泛系统的文献综述，以确定PubMed中所有提供非典型双相障碍、BD- nos、USBD、特异性双相障碍、快速循环双相障碍、鉴于缺乏任何早期形式的双相障碍在达到BP I或BP II诊断之前的药物治疗文献，我们认为有必要对现有的早期表现和前驱症状的文献进行回顾，现在属于指定（BD S-USBD）的标题。在这里，重点是流行的BP- nos亚型，它符合BP的所有经典表现，除了短暂的躁狂持续时间，以及一种更新认识的S-USBD形式，称为TSDD。结果确定了11项以家庭为中心的心理治疗研究，其中9项随机对照试验（rct）与对照组相比结果一致阳性，对照组采用常规治疗（TAU）治疗S-USBD亚型和亚型不明确。仅报道了三项精神药理学随机对照试验，其中只有一项关于阿立哌唑对高危儿童S-USBD未指明亚型的治疗与安慰剂有显著差异。除了一项专门针对TSDD亚型的研究外，没有一项对照试验和只有两个病例系列提供了S-USBD亚型的单独结果数据。这两个病例系列报告初步定义了TSDD亚型，并提供了新的药物治疗数据，包括锂、可乐定和氯胺酮，取得了良好的效果。结论11项研究均支持采用以家庭为中心的辅助心理治疗方法，该方法应作为任何治疗方案的重要组成部分。S-USBD的药物治疗前景缺乏系统的研究基础，需要通过对照临床试验进一步探索。病例系列表明，使用大剂量锂、可乐定、氯胺酮和其他冷却措施治疗TSDD的效果很好。需要在对照试验中验证这种新的治疗策略，以推进S-USBD变体的管理。

{"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}

引用次数: 0

The Catatonia Quick Screen (CQS): A Rapid Screening Tool for Catatonia in Adult and Pediatric Populations 紧张症快速筛查（CQS）：成人和儿童紧张症的快速筛查工具

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-06 DOI: 10.1111/acps.13820

James Luccarelli, Mark Kalinich, Jo Ellen Wilson, Jonathan P. Rogers, Jinyuan Liu, D. Catherine Fuchs, Andrew Francis, Stephan Heckers, Gregory Fricchione, Joshua Ryan Smith

Introduction

Catatonia is a potentially lethal and frequently underdiagnosed neuropsychiatric disorder marked by significant disturbances in motor, cognitive, and affective functioning. To enhance clinical detection of catatonia, this study aimed to develop and independently validate a rapid, sensitive Catatonia Quick Screen (CQS) using a reduced set of catatonic signs to facilitate screening in both adult and pediatric patients.

Methods

Training data were derived from two retrospective cohorts totaling 446 patients (254 adults, 192 children) who screened positive for catatonia using the Bush Francis Catatonia Screening Instrument (BFCSI). The sensitivity of every potential combination of BFCSI signs was calculated from these data, with sensitivity defined as the proportion of patients identified by each combination of signs relative to the full BFCSI. The CQS was developed by selecting the combination of signs from the BFCSI that offered high sensitivity, ease of assessment by non-expert providers, and relevance to diverse catatonia presentations. The CQS was then validated in an independent 1456 patient cohort.

Results

Using only four of the full BFCSI's 14 signs—excitement, mutism, staring, and posturing—yielded a sensitivity of 97% (95% CI: 95%–98%) relative to the BFCSI across both pediatric and adult patients within the training data. The CQS showed only a modest decrease in sensitivity (91%; 95% CI: 90%–93%) relative to the BFCSI when tested on the independent 1456 patient validation cohort.

Conclusion

The CQS provides an independently validated, high sensitivity, rapid, and easy to use screening alternative to the BFCSI, potentially improving early detection of catatonia in clinical settings. A positive CQS should lead to a more detailed and definitive assessment for catatonia. Future prospective studies are necessary to determine the specificity of the CQS in diverse clinical populations.

紧张症是一种潜在的致命的、经常被误诊的神经精神疾病，其特征是运动、认知和情感功能的显著障碍。为了加强临床对紧张症的检测，本研究旨在开发并独立验证一种快速、敏感的紧张症快速筛查（CQS），使用一组减少的紧张症体征来促进成人和儿童患者的筛查。方法训练数据来自两个回顾性队列，共446例患者（成人254例，儿童192例），均使用Bush Francis紧张症筛查仪（BFCSI）筛查出紧张症阳性。根据这些数据计算每一种潜在BFCSI体征组合的敏感性，敏感性定义为每一种体征组合所识别的患者相对于完整BFCSI的比例。CQS是通过选择BFCSI的体征组合而开发的，这些体征具有高灵敏度，易于非专业提供者评估，并且与各种紧张症表现相关。然后在一个独立的1456例患者队列中验证CQS。结果：在训练数据中，仅使用BFCSI全部14个体征中的4个——兴奋、缄默、凝视和姿势——相对于BFCSI的灵敏度为97% (95% CI: 95% - 98%)，适用于儿科和成人患者。当在独立的1456例患者验证队列中进行测试时，CQS显示相对于BFCSI的敏感性仅略有下降（91%;95% CI: 90%-93%）。结论CQS是一种独立验证、灵敏度高、快速、简便的筛查方法，可替代BFCSI，有望提高临床对紧张症的早期发现。CQS阳性应导致对紧张症更详细和明确的评估。未来的前瞻性研究有必要确定CQS在不同临床人群中的特异性。

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引用次数: 0

Impact of Obstetric Complications in Subjects at Clinical High Risk for Psychosis: A Systematic Review and Meta-Analysis 产科并发症对临床精神病高危患者的影响：一项系统回顾和荟萃分析

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-04 DOI: 10.1111/acps.13816

Inmaculada Baeza, Jordina Tor, Elena de la Serna, Gisela Sugranyes, Fàtima Crispi, Montserrat Izquierdo-Renau, Marta del Olmo, Montserrat Dolz, Clemente García-Rizo

Introduction

Exposure to obstetric complications (OCs) increases the risk of developing psychosis and schizophrenia in offspring. However, studies with subjects at clinical high risk for psychosis (CHR) have reported inconsistent results. We conducted a systematic review and meta-analysis to evaluate the prevalence of OCs among CHR subjects and controls and examine their impact on the transition to psychosis.

Methods

Four databases (Web of Science, PubMed, Latindex, and Dialnet) were systematically searched for articles published between 1995 and June 6, 2024. The risk of bias was assessed using the Newcastle–Ottawa scale. Articles providing data on OCs in CHR subjects were included.

Results

A total of 6037 records were retrieved through systematic and citation searches. Nine articles met the inclusion criteria for our systematic review and provided data for meta-analysis. A total of 555 CHR participants were included. Meta-analysis showed a significantly higher prevalence of OCs in CHR subjects versus controls: RR = 1.45 (95% CI: 1.16, 1.81), (Z = 3.27, p = 0.0011). Data from three longitudinal studies assessed transition to psychosis and our meta-analysis found a trend toward an increased risk of transition in CHR subjects with a history of OCs compared to others: RR = 2.05 (95% CI: 0.98, 4.26), Z = 1.91, p = 0.056.

Conclusions

CHR for psychosis was associated with OCs, though their role in the transition to psychosis requires further study. OCs should be recorded and analyzed in CHR individuals, considering their potential clinical implications.

暴露于产科并发症（OCs）会增加后代患精神病和精神分裂症的风险。然而，对临床精神病高危人群（CHR）的研究报告了不一致的结果。我们进行了一项系统回顾和荟萃分析，以评估CHR受试者和对照组中OCs的患病率，并检查其对向精神病过渡的影响。方法系统检索Web of Science、PubMed、Latindex和Dialnet 4个数据库1995年至2024年6月6日期间发表的论文。偏倚风险采用纽卡斯尔-渥太华量表进行评估。纳入了提供CHR受试者OCs数据的文章。结果通过系统检索和引文检索，共检索到文献6037篇。9篇文章符合我们系统评价的纳入标准，并为meta分析提供了数据。共纳入555名CHR参与者。荟萃分析显示，CHR组的OCs患病率明显高于对照组：RR = 1.45 (95% CI: 1.16, 1.81), （Z = 3.27, p = 0.0011）。三项纵向研究的数据评估了向精神病的转变，我们的荟萃分析发现，与其他人相比，有OCs病史的CHR受试者的转变风险有增加的趋势：RR = 2.05 (95% CI: 0.98, 4.26), Z = 1.91, p = 0.056。结论精神病的CHR与OCs相关，但OCs在向精神病过渡中的作用有待进一步研究。考虑到其潜在的临床意义，应记录和分析CHR患者的OCs。

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引用次数: 0

The Safety of 12-Weekly Monitoring of Neutrophil Count in Long-Term Clozapine Patients 长期氯氮平患者12周中性粒细胞计数监测的安全性

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-03 DOI: 10.1111/acps.13818

David Taylor, Siobhan Gee, Marinka Helthuis, Ebenezer Oloyede

Introduction

Clozapine is the only truly effective treatment for refractory schizophrenia, but its use is constrained by the requirements for frequent monitoring of neutrophil counts. In the UK during the COVID-19 pandemic, the frequency of clozapine blood monitoring was reduced in some units from 4-weekly to 12-weekly. We aimed to investigate the outcomes of reduced monitoring in long-term clozapine patients.

Methods

This was an anonymous, retrospective, observational cohort study. No restrictions were applied regarding care setting (i.e., outpatients or inpatients). All patients who registered for reduced frequency haematological monitoring from 1 March 2020 to 1 November 2022 were included and followed up till 1 August 2024. The primary outcome was death resulting from clozapine-induced agranulocytosis (CIA). Secondary outcomes were the proportion of patients with mild to moderate neutropenia during the follow-up period and the proportion of patients who reverted to standard monitoring during the study period.

Results

Amongst 1025 patients, there were no cases of agranulocytosis over 3365.9 patient-years of 12-weekly blood monitoring (incident rate 0.0 per 100 person-years). There were 43 episodes of mild neutropenia (so-called amber results—1.5–2.0 × 10⁹/L) or neutropenia (red results < 1.5 × 10⁹/L), an overall incident rate of 1.28 per 100 person-years. During follow-up, 41 patients (4%) reverted permanently to standard 4-weekly monitoring, and 157 patients (15%) temporarily interrupted reduced frequency monitoring but restarted 12-weekly monitoring before the end of the follow-up period. In total, 42 patients (4%) died during the observation period—no death was related to agranulocytosis.

Conclusion

Reducing the frequency of clozapine haematological monitoring to 12-weekly was safe in a group of long-term patients. No cases of agranulocytosis occurred and no deaths due to agranulocytosis were recorded. Most patients remained on extended-interval monitoring.

氯氮平是治疗难治性精神分裂症唯一真正有效的药物，但其使用受到频繁监测中性粒细胞计数要求的限制。在英国，在COVID-19大流行期间，氯氮平血液监测的频率在一些单位从4周减少到12周。我们的目的是调查长期氯氮平患者减少监测的结果。方法本研究为匿名、回顾性、观察性队列研究。没有对护理环境（即门诊病人或住院病人）施加限制。纳入了从2020年3月1日至2022年11月1日登记进行低频率血液学监测的所有患者，并随访至2024年8月1日。主要终点是氯氮平所致粒细胞缺乏症（CIA）导致的死亡。次要结局是随访期间轻度至中度中性粒细胞减少症患者的比例以及研究期间恢复标准监测的患者比例。结果在1025例患者中，在12周血液监测的3365.9患者-年（发病率为0.0 / 100人-年）中没有出现粒细胞缺乏症。有43例轻度中性粒细胞减少（所谓的琥珀色结果- 1.5 - 2.0 × 109/L）或中性粒细胞减少（红色结果- 1.5 × 109/L），总发病率为1.28 / 100人年。在随访期间，41例患者（4%）永久恢复标准的4周监测，157例患者（15%）暂时中断减少频率的监测，但在随访期结束前重新开始12周监测。观察期间共42例（4%）死亡，无粒细胞缺乏症相关死亡。结论降低氯氮平血液学监测频率至12周对长期患者是安全的。无粒细胞缺乏症病例发生，无粒细胞缺乏症死亡记录。大多数患者仍接受延长间隔监测。

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引用次数: 0

Beyond Highs and Lows: Unraveling Cannabis Withdrawal-Induced Mania—A Two-Year Observational Study of Hospital Admissions From 2015 to 2019 超越高潮和低谷：解开大麻戒断引起的躁狂——2015年至2019年住院情况的两年观察性研究

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-05-01 DOI: 10.1111/acps.13819

Iñaki Ochandiano, Sergi Salmerón, Helena Andreu, Luis Olivier, Oscar de Juan, Tabatha Fernández-Plaza, Lluc Colomer, Roger Borràs, Marc Valentí, Michael Berk, Ana Cristina Andreazza, Eduard Vieta, Anna Giménez-Palomo, Isabella Pacchiarotti

Introduction

Bipolar disorder (BD) is a chronic and recurrent psychiatric illness characterized by alternating episodes of mania and/or hypomania and depression. The endocannabinoid system (ECS) is a vast network of chemical signals and cellular receptors that are densely packed throughout the brain. It is involved in the most critical central nervous system functions, such as learning and memory, and also mood regulation. Despite this, there is only anecdotal evidence on the potential role of the ECS in the pathophysiology of BD.

Objectives

This study aims to retrospectively assess clinical and sociodemographic variables of patients who presented a manic episode that was chronologically associated with the suspension of cannabis use, compared to patients with a manic episode with no relation to cannabis use or suspension. The objective of the study is to investigate the presence of a specific group of patients with BDs, with potential clinical and therapeutic implications.

Methods

We retrospectively evaluated all admitted patients to the acute psychiatry unit at Hospital Clinic of Barcelona from 2015 to 2019 who were hospitalized for a manic episode. Cannabis withdrawal-induced mania (CWIM) was considered if cessation of regular cannabis use up to 21 days before the initial manic symptoms was mentioned in clinical and toxicological history and symptoms were prolonged for longer than 15 days after cessation. We used descriptive statistics to extract most of the information.

Results

Between 2015 and 2019, 282 patients were admitted to the acute psychiatry unit with a diagnosis of a manic episode. Twenty of them (7.09%) met criteria for CWIM, and they were compared retrospectively with the rest of the patients with non-cannabis related manic (n = 262). Patients with CWIM group were more frequently men (p = 0.015) and younger (p < 0.001), were not married or in a relationship (p = 0.018) and less frequently had somatic illnesses (p = 0.041) compared to patients with non-cannabis-related manic. Moreover, patients with CWIM had their first manic episode and had their first psychiatry admission at a significantly younger age compared with the other group (p = 0.008 and p = 0.004, respectively). Previous treatment with any antipsychotic medication was significantly less frequent in the CWIM group (p = 0.022). According to follow-up, there were no significant differences in relapse after 3 years (p = 0.936) among the two groups.

双相情感障碍（BD）是一种慢性和复发性精神疾病，其特征是躁狂和/或轻躁狂和抑郁交替发作。内源性大麻素系统（ECS）是一个由化学信号和细胞受体组成的庞大网络，密集地分布在整个大脑中。它参与了最关键的中枢神经系统功能，如学习和记忆，以及情绪调节。尽管如此，关于ECS在双相障碍病理生理学中的潜在作用，只有轶事证据。目的本研究旨在回顾性评估与大麻使用暂停相关的躁狂发作患者的临床和社会人口学变量，与与大麻使用或暂停无关的躁狂发作患者进行比较。该研究的目的是调查一组特定的BDs患者的存在，具有潜在的临床和治疗意义。方法回顾性评估2015 - 2019年巴塞罗那医院门诊急性精神科收治的所有躁狂发作患者。如果在临床和毒理学史中提到最初的躁狂症状前21天停止常规大麻使用，并且症状在停止后延长超过15天，则认为是大麻戒断引起的躁狂。我们使用描述性统计来提取大部分信息。结果2015年至2019年期间，282名患者被诊断为躁狂发作而入住急性精神病学病房。其中20例（7.09%）符合CWIM标准，并与其余非大麻相关躁狂患者（n = 262）进行回顾性比较。与非大麻相关的躁狂患者相比，CWIM组患者更多是男性（p = 0.015），更年轻（p < 0.001），没有结婚或恋爱（p = 0.018），更少患有躯体疾病（p = 0.041）。此外，与其他组相比，CWIM患者第一次躁狂发作和第一次精神病学入院的年龄明显更年轻（p = 0.008和p = 0.004）。CWIM组既往接受任何抗精神病药物治疗的频率显著低于对照组（p = 0.022）。经随访，两组3年后复发率差异无统计学意义（p = 0.936）。结论：本研究发现了一种新的临床特征，在双相患者中，大麻戒断的患者更有可能出现躁狂发作。这样一种特征的存在，主要是没有精神病史的年轻男性，可能与ECS的作用有关，直到现在在双相障碍中几乎被忽视。这些特征表明躁狂发作的物质次生起源，如果在治疗期间考虑一级预防物质相关治疗，可能会有更少的遗传负荷和更好的结果。我们的数据可以鼓励基础和临床研究，以确定大麻和大麻素（CBs）如何影响情绪，并研究基于大麻素的新选择作为可能的治疗方法。

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