Acta Psychiatrica Scandinavica最新文献_第9页

Reaching ADHD Treatment Targets? 达到ADHD治疗目标？

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-04-24 DOI: 10.1111/acps.13815

Søren Dalsgaard, Maj-Britt Posserud, Kamilla W. Miskowiak, Kenneth K. C. Man

<p>In a recent epidemiological study, Grøntved et al. present important results on the temporal changes of the rates in prevalence and incidence of ADHD diagnosis and use of ADHD medication in Denmark over the past two decades [<span>1</span>]. The authors have applied stringent, robust, and sound methods in analyzing individual-level data available from the Danish nationwide registers. Their main findings include consistent increases in the prevalence and incidence of diagnosis of ADHD and corresponding increases in pharmacological treatment across sex and age groups from 2000 to 2022. The most notable increase in recent years is observed in young adult women. They found that 3.03% of the total population living in Denmark was given a clinical diagnosis of ADHD or had received treatment with ADHD medication in 2022. Among children and adolescents aged 6–18 years, it was 4.0%; in adults aged 18–27 years, it was 7.1%; in adults aged 27–35 years, it was 6.1%; and in adults aged 35–50 years, it was 3.5%, all as observed in 2022.</p><p>The study offers valid and precise estimates of the number of individuals diagnosed with ADHD or treated with ADHD medications within the entire Danish population and of the increases in those rates over a 20-year period. Such high-quality population-based estimates of the yearly prevalence and incidence of ADHD are much needed, as these measures of occurrence focus on the absolute risk, answering the question “What is the actual percentage?” Many articles in news media [<span>2, 3</span>] and also some scientific studies [<span>4</span>] only focus on the relative increase in number of diagnosed or treated over a certain time period, not on the prevalence rate. Similarly, a former Minister of Health in Denmark [<span>5</span>], and some governmental reports from authorities have raised concerns about the relative increase in the use of ADHD medication, while others have reported incorrect prevalence rates of clinical diagnoses of ADHD, as they have relied on too simplistic methodologies [<span>6</span>]. The study by Grøntved et al. overcomes such methodological limitations and reports valid and less biased estimates of the rates of prevalence and incidence of ADHD diagnosis and treatment. This is important, because in order to evaluate whether there is reason for concerns about over-diagnosing or overtreatment of ADHD, one needs to compare the rates of diagnoses and use of ADHD medication with the expected occurrence of the disorder.</p><p>Studies on the underlying occurrence of ADHD in the population suggest that 6%–7% of all children and adolescents fulfill diagnostic criteria for the disorder [<span>7</span>], and the occurrence in the population seems to have been stable for several decades [<span>8, 9</span>]. In adults, 4%–5% of the population fulfill diagnostic criteria for ADHD [<span>10</span>]. These studies also show that children and adolescents fulfilling diagnostic criteria for ADHD are less common in g

在最近的一项流行病学研究中，Grøntved等人对丹麦过去20年ADHD诊断和ADHD药物使用的患病率和发病率的时间变化给出了重要的结果[10]。作者在分析丹麦全国登记的个人数据时采用了严格、稳健和合理的方法。他们的主要发现包括从2000年到2022年，不同性别和年龄组的ADHD患病率和发病率持续增加，药物治疗也相应增加。近年来最显著的增长发生在年轻成年妇女身上。他们发现，在2022年，丹麦总人口中有3.03%的人被诊断为多动症或接受过多动症药物治疗。在6-18岁的儿童和青少年中，为4.0%；在18-27岁的成年人中，这一比例为7.1%；在27-35岁的成年人中，为6.1%；在35-50岁的成年人中，这一比例为3.5%，这些数据都是在2022年观察到的。该研究对整个丹麦人口中被诊断患有ADHD或接受ADHD药物治疗的个体数量以及这些比率在20年期间的增长情况提供了有效和准确的估计。这种高质量的基于人群的ADHD年度患病率和发病率的估计是非常必要的，因为这些发生率的测量侧重于绝对风险，回答了“实际百分比是多少”的问题。新闻媒体上的许多文章[2,3]和一些科学研究[bbb]只关注在一定时期内诊断或治疗人数的相对增长，而不是患病率。同样，丹麦前卫生部长b[5]和一些政府当局的报告对ADHD药物使用的相对增加表示担忧，而其他人则报告了ADHD临床诊断的不正确患病率，因为他们依赖过于简单的方法b[6]。Grøntved等人的研究克服了这种方法学上的局限性，报告了对ADHD诊断和治疗的患病率和发病率的有效且较少偏差的估计。这很重要，因为为了评估是否有理由担心多动症的过度诊断或过度治疗，人们需要将多动症的诊断率和药物使用率与疾病的预期发生率进行比较。关于ADHD在人群中潜在发生的研究表明，所有儿童和青少年中有6%-7%的人符合ADHD的诊断标准，并且在人群中的发生似乎已经稳定了几十年[8,9]。在成年人中，4%-5%的人符合ADHD的诊断标准。这些研究还表明，符合ADHD诊断标准的儿童和青少年中，女孩比男孩少（1:2的性别比例），而在成人中则没有差异（1:1的性别比例）。因此，Grøntved等报道的6-18岁儿童ADHD诊断患病率(4.02%；（女性占2.7%，男性占5.3%）略低于预期，性别差异与预期一致（1:1.97）。这些结果与先前的研究结果一致，并且令人放心，因为它们表明，在丹麦，ADHD在儿童和青少年中没有被过度诊断或过度治疗，而在一些国家，如美国、加拿大和冰岛[12-14]可能存在这种情况。在这些国家中，与班上年龄最大的孩子相比，班上年龄最小的孩子更有可能被诊断患有多动症或接受多动症药物治疗。丹麦是少数几个没有发现这种关联的国家之一[16,17]。相比之下，Grøntved等人报告的18-35岁成年人中ADHD的患病率（6%-7%）可能会引起一些关注，因为这略高于预期的比率。2012年，18-27岁男性的患病率已经达到预期的4%-5%，女性的患病率在2019年达到了预期的4%-5%。尽管如此，该年龄组的ADHD发病率在男女中都持续增加，尤其是在女性中。在过去的5年里，年轻成年女性中ADHD发病率的高增长可能与这样一个事实有关：几十年来，患有ADHD的女孩不太可能被识别和诊断出来，因为它以前被认为是一种只影响男孩的儿童疾病。当这些误解最终被纠正时，这意味着许多女孩被诊断为青少年，而这种诊断的延迟也部分解释了我们现在在成年女性中看到的发病率急剧上升。Grøntved等人的研究支持了先前的研究，即在丹麦，儿童和青少年中ADHD没有被过度诊断或过度治疗。这可能与以下事实有关：大多数儿童是在地区医院部门进行诊断的，经过广泛的跨学科评估，由经过儿童和青少年精神病学专家培训的医生、临床心理学家、护士和社会工作者，以及通常在儿童日常环境中进行直接观察的教学人员进行评估。所以在丹麦，我们似乎达到了诊断和治疗儿童和青少年多动症的目标。成人ADHD的临床评估是一项具有挑战性的任务。目前的诊断依赖于临床访谈和自我报告或举报人报告量表，这些量表容易受到偏见和装病的影响，增加了误诊的风险。此外，通常很难获得关于ADHD症状的严重程度和数量以及儿童时期所经历的损害程度的有效信息。尽管存在这些挑战，大多数对患有多动症的成年人的评估并不是由一个跨学科的团队进行的，就像大多数儿童和青少年的情况一样。相反，大多数成年人是由私人诊所的精神科医生诊断的，通常是基于单一学科的评估。此外，成人多动症的评估直到最近才被纳入成为有执照的精神科医生的培训中[10]，尽管许多精神科医生经历了大量的ADHD评估转介[1]。成人ADHD发病率的明显增加可能与评估需求水平与能力水平之间的不平衡有关，再加上成人服务中缺乏正式培训和过于简单的诊断实践。未来卫生服务的规划应考虑到这一点，重点是对专家进行更好的临床培训，并对患有多动症的成年人进行更广泛的跨学科评估。提高成人多动症诊断准确性的一种方法是开发新技术，并确定改善的生物标记物。结合行为和生理数据的多模式方法是提高诊断精度的一个有希望的解决方案。特别是，虚拟现实（VR）和人工智能的最新进展使更客观，生态有效的评估成为可能。例如，沉浸式虚拟现实环境中的注意力任务——比如一个有现实干扰物的虚拟会议室——已经被证明可以可靠地区分患有多动症的成年人和健康对照组。新兴的机器学习模型整合了来自类似现实生活的VR场景的数据，包括认知表现、凝视行为、头部运动和自我报告的注意力不集中，可能会进一步提高诊断的准确性。总之，这些工具能够向更精确、多维度的评估策略转变，以帮助成人多动症的诊断准确性。总而言之，Grøntved等人的论文与最近的其他研究结果一致，并为这一临床重要领域增加了新的详细信息。总的来说，数据表明，我们必须意识到，在成年人中，过度诊断和过度治疗多动症的风险在增加，尤其是在女性中。这种发展是不幸的，因为它可能，例如，危及提供服务和淡化诊断的意义。临床医生应遵守ADHD的评估标准，如国际指南bbb所推荐的。为了避免过度诊断和过度治疗成人多动症的风险不断增加，我们必须确保对成人病例的评估反映出临床应用于儿童病例的跨学科严谨性，以标准化协议为基础，并通过VR等新兴新技术得到加强，这些技术为行为和生理学提供客观、生态有效的见解。这篇论文是由s.d.构思的，他也写了初稿。m.b.p.、k.w.m.和K.K.C.M.对草稿进行了修改，四位作者都批准了最终版本。在过去的三年里，他获得了伦德贝克、Gedeon Richter和Angelini的酬金。SD， MBP和kkcm声明没有利益冲突。

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引用次数: 0

Editorial on: The Underappreciated Importance of Mania 社论：狂热的重要性未被充分认识

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-04-21 DOI: 10.1111/acps.13814

Susan L. McElroy, Mark A. Frye, Balwinder Singh

<p>In this issue of Acta Psychiatrica Scandinavica, Drs. Manchia, Miola, Tondo, and Baldessarini [<span>1</span>] provide an important study of individuals with unipolar mania (UPM), defined by these authors as mania or hypomania without depressive episodes. In their study, Manchia and colleagues identified 63 consecutive individuals with UPM and compared them over the long term (up to 9.18 years) to 1210 patients with regular bipolar disorder (mania or hypomania with depressive episodes; BD) recruited from expert mood disorder centers across Italy. Compared with regular BD, the authors found that UPM was uncommon (4.5% of all BD cases over 18.2 years of risk), more common in men, predominantly BD type I (only 0.314% had unipolar hypomania), associated with more psychosis but less suicidality, and associated with greater use of antipsychotics, lithium, and mood-stabilizing anticonvulsants but much less use (27% less) of antidepressants. Over a mean follow-up of 9.18 years, the rate of UPM decreased, suggesting that some of these patients will eventually develop a first depressive episode.</p><p>Many of these findings have been noted in earlier, mostly cross-sectional studies using various definitions of UPM. For example, in a 2023 meta-analysis of 21 studies, UPM was similarly uncommon and associated with male gender and psychotic features, but with fewer suicide attempts [<span>2, 3</span>]. Other findings have included higher rates of hyperthymia, good sleep quality, and morning chronotype in UPM than in regular BD [<span>2-4</span>].</p><p>We were particularly interested in three issues arising from this important article.</p><p>First is regarding the prevalence of UPM. Many studies have suggested that UPM is a relatively uncommon form of BD. Thus, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that, using three definitions of UPM, 5.0%–7.2% of individuals from the U.S. with BD type I never had depression [<span>5</span>]. However, evidence exists that UPM may be more common in low-income versus high-income countries. Thus, a study from Ethiopia found 41.7% of participants had UPM [<span>6</span>], while a study from Tunisia found a rate of 56.6% [<span>7</span>]. Although these differences in prevalence rates could be due to methodological issues, including use of different definitions of UPM, one wonders if there are cultural differences regarding the etiology and recognition of BD, particularly manic symptoms. If such cultural issues exist, it would be important to understand them.</p><p>Second is the finding that morning chronotype may be more common in UPM while evening chronotype appears to be more common in regular BD. Our group indeed found that evening chronotype was more common among individuals participating in a BD biobank, and that it was associated with more depressive episodes than participants with non-evening chronotypes [<span>8</span>]. Circadian rhythm dysfunction has been implicated in t

在这一期的《斯堪的纳维亚精神病学学报》上，Manchia、Miola、Tondo和Baldessarini等人对单极躁狂（UPM）进行了一项重要的研究，这些作者将其定义为无抑郁发作的躁狂或轻躁狂。在他们的研究中，Manchia及其同事确定了63名连续的UPM患者，并将他们长期（长达9.18年）与1210名常规双相情感障碍患者(躁狂或轻躁狂伴抑郁发作；从意大利各地的情绪障碍专家中心招募。与常规双相障碍相比，作者发现UPM不常见（占18.2年风险的所有双相障碍病例的4.5%），在男性中更常见，主要是双相障碍I型（只有0.314%患有单极轻躁狂），与更多的精神病患者相关，但自杀倾向较少，与更多使用抗精神病药物，锂和情绪稳定抗惊厥药物相关，但使用抗抑郁药物较少（减少27%）。在平均9.18年的随访中，UPM的发生率下降，这表明其中一些患者最终会出现首次抑郁发作。许多这些发现已经在早期被注意到，主要是使用各种UPM定义的横断面研究。例如，在2023年对21项研究的荟萃分析中，UPM同样不常见，与男性性别和精神病特征有关，但自杀企图较少[2,3]。其他研究结果还包括UPM患者比常规BD患者有更高的胸气亢进率、良好的睡眠质量和晨间睡眠类型[2-4]。我们对这篇重要文章引起的三个问题特别感兴趣。首先是关于UPM的流行。许多研究表明，UPM是一种相对罕见的双相障碍。因此，国家酒精及相关疾病流行病学调查（NESARC）发现，使用UPM的三种定义，5.0%-7.2%的美国双相障碍I型患者从未患过抑郁症。然而，有证据表明，UPM可能在低收入国家比高收入国家更常见。因此，来自埃塞俄比亚的一项研究发现41.7%的参与者有UPM[7]，而来自突尼斯的一项研究发现56.6%的参与者有UPM[7]。虽然这些患病率的差异可能是由于方法问题，包括使用不同的UPM定义，但人们想知道在双相障碍的病因和认知方面是否存在文化差异，特别是躁狂症状。如果存在这样的文化问题，了解它们是很重要的。其次，我们发现晨起型可能在UPM患者中更常见，而夜间型似乎在常规BD患者中更常见。我们的研究小组确实发现，夜间型在BD生物样本库的个体中更常见，而且与非夜间型[8]的参与者相比，它与更多的抑郁发作有关。昼夜节律功能障碍与BD的病理生理有关。也许对广义双相障碍的时间型的更深入的了解将为这种疾病的病理生理学提供重要的线索。第三个问题是低躁/躁症状的临床重要性，以及这些症状如何提供一些诊断和治疗特异性，但往往被精神病学领域所忽视。例如，DSM[10]和ICD11仍然要求症状持续4天才能诊断为轻躁狂，尽管有证据表明轻躁狂的有效持续时间也可以是1天、2天或3天。同样，DSM和ICD都规定躁狂发作必须持续至少7天，除非症状引发住院或其他治疗干预[10,11]。如果这些症状引发了机动车事故、暴力行为或与司法系统接触怎么办？我们认为这样的DSM要求对低/躁狂症状的诊断是有偏见的，低/躁狂症状可能比焦虑、抑郁甚至精神病症状提供更大的诊断和治疗特异性。简而言之，越来越多的文献表明，一部分有躁狂或轻躁发作的个体将不会再有抑郁发作。我们同意Manchia博士及其同事的观点，认为将UPM确定为双相障碍的一种亚型是合理的。然而，重要的是要认识到，一种亚型的双相障碍可以转变为另一种亚型，而且关于如何治疗长期UPM且首次发作抑郁发作的个体的信息很少。因此，治疗这些个体需要对这种疾病的现象学和药理学有深入的了解。起草初稿。M.A.F.和B.S.提供了反馈和编辑。三位作者都参与并批准了最终的手稿。Susan L. McElroy是Axsome、Idorsia、Kallyope、Levo、Novo Nordisk和Soleno的顾问或科学顾问委员会成员。她是Axsome和万豪基金会赞助的研究的主要或共同研究者。她也是美国专利号6,323,236 B2的发明人，使用磺胺酸衍生物治疗冲动控制障碍，并与该专利的受让人，俄亥俄州辛辛那提市的辛辛那提大学一起，收到了强生公司的付款；强生公司拥有这项专利的专有权。Mark Frye博士是卡诺实验室和美国医师协会科学顾问委员会的顾问或成员。他是由Assurex Health、Baszucki Group、突破性发现治疗双相情感障碍（BD2）和梅奥基金会赞助的研究的主要或共同研究者。他还拥有Chymia LLC的经济权益/股权/版权费。Balwinder Singh博士获得了梅奥诊所、国家抑郁症中心网络（NNDC）、双相情感障碍（BD2）突破性发现和NIH的研究资助支持。他是KL2指导职业发展计划的学者，由国家促进转化科学中心（NCATS）的CTSA资助号KL2TR002379支持。辛格博士因编辑《难治性抑郁症临床综述》而获得了爱思唯尔的酬金（给梅奥诊所）。

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引用次数: 0

The Influence of Childhood Trauma on the Real-World Effectiveness of Ketamine in Adults With Treatment-Resistant Depression 童年创伤对成人难治性抑郁症氯胺酮实际疗效的影响

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-04-16 DOI: 10.1111/acps.13812

Danica E. Johnson, Nelson B. Rodrigues, Rodrigo B. Mansur, Roger S. McIntyre, Joshua D. Rosenblat

Introduction

Childhood trauma is a well-established risk factor for major depressive disorder (MDD) and is often associated with attenuated response to conventional antidepressant therapies. Ketamine has emerged as an effective treatment for treatment-resistant depression (TRD), but the impact of childhood trauma on its effectiveness remains unclear. Herein, we aimed to determine whether childhood trauma influences the antidepressant effectiveness of ketamine in TRD.

Methods

A retrospective analysis was performed on data from adults with TRD (n = 83) who received four ketamine infusions at a community outpatient clinic. Participants were categorized based on cumulative trauma load (high vs. low) and specific trauma types, assessed by the Childhood Trauma Questionnaire (CTQ). Depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology Self-Report 16-item (QIDS-SR16) at baseline and following each infusion. Linear mixed models and chi-square tests were used to evaluate the impact of trauma on ketamine's antidepressant effectiveness.

Results

Depressive symptoms significantly decreased across all participants over time, with an average reduction of 5.7 points in QIDS-SR16 scores (p < 0.001). High childhood trauma load was reported by 55% of participants. Response rates were 25% in the high trauma load group and 19% in the low trauma load group, while remission rates were 14% and 11%, respectively. However, there were no significant differences in antidepressant effectiveness (p = 0.572), response rates (p = 0.230), or remission rates (p = 0.397) between participants with high versus low trauma loads. Further analysis also revealed no significant associations between specific types of childhood trauma and antidepressant effectiveness, response, or remission outcomes.

Conclusion

Childhood trauma did not attenuate ketamine's antidepressant effectiveness in TRD. These findings support ketamine as a viable treatment for individuals with TRD, including those with significant trauma histories. Further research is warranted to replicate these findings and explore underlying mechanisms.

童年创伤是重度抑郁障碍（MDD）的一个公认的危险因素，通常与传统抗抑郁治疗的反应减弱有关。氯胺酮已成为治疗难治性抑郁症（TRD）的有效方法，但儿童创伤对其有效性的影响尚不清楚。在此，我们旨在确定童年创伤是否会影响氯胺酮在TRD中的抗抑郁效果。方法回顾性分析83例在社区门诊接受4次氯胺酮输注的TRD患者的资料。参与者根据累积创伤负荷（高与低）和特定创伤类型进行分类，并通过儿童创伤问卷（CTQ）进行评估。在基线和每次输注后使用抑郁症状自我报告快速量表16项（QIDS-SR16）测量抑郁症状。采用线性混合模型和卡方检验评价创伤对氯胺酮抗抑郁疗效的影响。结果：随着时间的推移，所有参与者的抑郁症状显著减轻，QIDS-SR16评分平均降低5.7分（p < 0.001）。55%的参与者报告了高童年创伤负荷。高创伤负荷组的缓解率为25%，低创伤负荷组的缓解率为19%，缓解率分别为14%和11%。然而，在高创伤负荷和低创伤负荷的参与者之间，抗抑郁药物的有效性（p = 0.572）、反应率（p = 0.230）或缓解率（p = 0.397）没有显著差异。进一步的分析还显示，特定类型的儿童创伤与抗抑郁药的疗效、反应或缓解结果之间没有显著的关联。结论童年创伤并未减弱氯胺酮对TRD患者的抗抑郁作用。这些发现支持氯胺酮作为治疗TRD患者的可行方法，包括那些有严重创伤史的患者。需要进一步的研究来重复这些发现并探索潜在的机制。

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引用次数: 0

The Efficacy and Acceptability of Non-Invasive Brain Stimulation Interventions for Obsessive-Compulsive Disorder Management: A Network Meta-Analysis Based on 24 Stimulation Methods 非侵入性脑刺激干预治疗强迫症的有效性和可接受性：基于24种刺激方法的网络meta分析。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-31 DOI: 10.1111/acps.13809

Ping-Tao Tseng, Chih-Wei Hsu, Chao-Ming Hung, Chih-Sung Liang, Hung-Yu Wang, Brendon Stubbs, Andre F. Carvalho, Andre R. Brunoni, Kuan-Pin Su, Yu-Kang Tu, Yi-Cheng Wu, Tien-Yu Chen, Dian-Jeng Li, Pao-Yen Lin, Yen-Wen Chen, Kuo-Chuan Hung, Jiann-Jy Chen, Bing-Syuan Zeng, Cheng-Ta Li

Introduction

Despite the high lifetime prevalence and elevated disability rates, treatments for obsessive-compulsive disorder (OCD) have limited efficacy. Considering the abnormal connectivity in the cortical-striatal-thalamic-cortical loop circuits in OCD, several randomized controlled trials (RCTs) have addressed the efficacy of different non-invasive brain stimulation (NIBS) modalities for the management of OCD. However, these RCTs yielded inconclusive results.

Methods

This network meta-analysis (NMA) included RCTs of NIBS interventions, such as transcranial direct current stimulation (tDCS) and various repetitive transcranial magnetic stimulation (rTMS), in OCD patients. The primary outcomes were changes in the overall severity of OCD and acceptability (i.e., dropout rates).

Results

This NMA of 34 eligible RCTs (1089 participants) and 24 different NIBS interventions revealed that three NIBS interventions significantly improved overall OCD severity compared with sham controls, which were high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) [mean difference (MD) = −10.81, 95% confidence intervals (95% CIs) = −20.80 to −0.82], high-frequency deep TMS over the dorsal medial prefrontal cortex/anterior cingulate cortex (dmPFC/ACC) (MD = −9.74, 95% CIs = −16.42 to −3.06), and low-frequency rTMS over the right DLPFC (MD = −4.70, 95% CIs = −8.84 to −0.57).

Conclusions

This study highlighted that excitatory stimulation over the dmPFC/ACC and bilateral DLPFC, or inhibitory stimulation over the right DLPFC, was associated with significant improvements in overall OCD severity. Further large-scale RCTs with longer follow-up periods are needed to investigate the true impact of NIBS-based intervention to manage OCD.

Trial Registration:PROSPERO: CRD42023394953

导读：尽管强迫症终生患病率高，致残率高，但治疗效果有限。考虑到强迫症患者皮层-纹状体-丘脑-皮层环路的异常连通性，一些随机对照试验（rct）研究了不同的非侵入性脑刺激（NIBS）治疗强迫症的效果。然而，这些随机对照试验得出了不确定的结果。方法：本网络荟萃分析（NMA）纳入强迫症患者NIBS干预措施的随机对照试验，如经颅直流电刺激（tDCS）和各种重复性经颅磁刺激（rTMS）。主要结果是强迫症的总体严重程度和可接受性（即辍学率）的变化。结果:34项符合条件的随机对照试验（1089名参与者）和24种不同的NIBS干预的NMA显示，与假对照组相比，三种NIBS干预显著改善了强迫症的总体严重程度，即经背外侧前额叶皮层（DLPFC）的高频rTMS[平均差(MD) = -10.81, 95%置信区间(95% ci) = -20.80至-0.82]，经背内侧前额叶皮层/前扣带皮层（dmPFC/ACC）的高频深度TMS (MD = -9.74，95% ci = -16.42至-3.06)，而右侧DLPFC上的低频rTMS （MD = -4.70, 95% ci = -8.84至-0.57）。结论：本研究强调，dmPFC/ACC和双侧DLPFC的兴奋性刺激，或右侧DLPFC的抑制性刺激，与总体强迫症严重程度的显著改善有关。需要进一步的大规模随机对照试验和更长的随访期来调查基于nibs的干预对强迫症的真正影响。试验注册：PROSPERO: CRD42023394953。

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引用次数: 0

Interrelationships of Changes in Outcome Domains in Patients With Schizophrenia Spectrum Disorders: A Meta-Analysis 精神分裂症谱系障碍患者预后域变化的相互关系：一项荟萃分析

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-30 DOI: 10.1111/acps.13808

Lars de Winter, Auke Jelsma, Jentien M. Vermeulen, Astrid Vellinga, Jaap van Weeghel, Ilanit Hasson-Ohayon, Cornelis L. Mulder, Nynke Boonstra, Wim Veling, Lieuwe de Haan

Introduction

Patients with schizophrenia spectrum disorders (SSD) improve in several outcome domains over the course of illness, but to different degrees. In this meta-analysis, we investigated whether longitudinal changes in different outcome domains are associated with each other and which factors moderate these changes over time.

Methods

Our protocol was preregistered in PROSPERO (CRD42024504253). We included 109 studies, identified through searches in PsycInfo, PubMed, CINAHL, and Cochrane up until November 2023, investigating longitudinal changes in at least two outcome domains (symptoms, social functioning, cognition or personal recovery) for patients with SSD with at least 1 year follow-up. We calculated Pearson correlation coefficients for associations of changes between outcome domains. Potential moderating effects of demographic, clinical, social, or study characteristics were explored. Quality assessment was executed using the QUIPS tool.

Results

We found substantial positive associations between changes in symptoms, social functioning, and cognition. Especially, changes in negative symptoms and overall social functioning were associated with changes in several outcome domains. Changes in personal recovery were only associated with changes in symptoms. We found more substantial improvements in combinations of outcomes for patients with a shorter illness duration, females, a lower percentage of patients diagnosed with schizophrenia, and patients receiving treatment focused on targeted outcomes.

Conclusions

Symptoms, social functioning, and cognition often concurrently improve and may boost each other. This suggests that an integrated approach targeting several outcome domains jointly boosts long-term improvement. However, changes in personal recovery seem to occur separately from other outcome domains. Therefore, targeted attention for personal recovery is needed.

Trial Registration: PROSPERO: CRD42024504253

简介：精神分裂症谱系障碍（SSD）患者在疾病过程中在几个结果领域有所改善，但程度不同。在这项荟萃分析中，我们调查了不同结果域的纵向变化是否相互关联，以及哪些因素随着时间的推移缓和了这些变化。方法：我们的方案在PROSPERO （CRD42024504253）中预注册。我们纳入了109项研究，通过PsycInfo、PubMed、CINAHL和Cochrane的搜索确定，直到2023年11月，研究了至少1年随访的SSD患者至少两个结果领域（症状、社会功能、认知或个人恢复）的纵向变化。我们计算了结果域之间变化关联的Pearson相关系数。探讨了人口统计学、临床、社会或研究特征的潜在调节作用。使用QUIPS工具进行质量评估。结果：我们发现症状变化、社会功能和认知之间存在显著的正相关。特别是，负面症状和整体社会功能的变化与几个结果域的变化有关。个人恢复的变化仅与症状的变化有关。我们发现病程较短的患者、女性患者、诊断为精神分裂症的患者比例较低的患者以及接受靶向治疗的患者的综合结果有更大的改善。结论：症状、社会功能和认知往往同时改善，并可能相互促进。这表明，针对几个结果领域的综合方法可以共同促进长期改善。然而，个人康复的变化似乎与其他结果领域是分开发生的。因此，需要有针对性地关注个人康复。试验注册：PROSPERO: CRD42024504253。

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引用次数: 0

The Higher Dose-Adjusted Clozapine Concentrations in Non-Smokers With High CRP Levels May Be Associated With the Lower Daily Doses of Clozapine 高CRP水平的非吸烟者的高剂量调整氯氮平浓度可能与较低的每日氯氮平剂量有关。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-30 DOI: 10.1111/acps.13810

Yuki Kikuchi

引用次数: 0

Prevalence and Incidence of Attention Deficit/Hyperactivity Disorder in Denmark. A National Register-Based Open Cohort Study 丹麦注意缺陷/多动障碍的患病率和发病率。一项基于国家登记的开放队列研究。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-27 DOI: 10.1111/acps.13804

Simon Grøntved, Kathrine Hald, Christina Mohr-Jensen, Søren Paaske Johnsen, Jan Mainz, Jan Brink Valentin

Introduction

Rises in prevalence and incidence of the neurodevelopmental disorder Attention-deficit/Hyperactivity Disorder (ADHD) have been reported globally and estimated in Denmark previously. Nevertheless, differences in methodology hinder an assessment of the temporal evolution of ADHD based on published literature. The aim of this study was to consistently calculate the yearly prevalence and incidence proportions of ADHD and the use of ADHD medication in Denmark from 2000 to 2022.

Methods

We conducted an open cohort study using register data covering the entire Danish population. We defined ADHD as either having a hospital diagnosis of ADHD (ICD-10: F90.0, F90.1, F90.8, or F98.8), or having redeemed a prescription for ADHD medication.

Results

Of the included 7,748,837 persons, 2.52% had ADHD, of whom 58.33% were males. The prevalence of ADHD has increased from 0.10% in 2000 to 3.03% in 2022. Specifically for the 18–27-year-olds, the prevalence was 8.16% for males and 6.12% for females in the year 2022. For the incidence, the same age group peaked within the females in 2022 at 1.10%, whereas the male incidence was consistently highest in the 6–18-year-olds, peaking in 2022 at 0.94%. Total use of ADHD medication in the population also increased. Methylphenidate was used by 97.58% of the ADHD medicated patients in 2000 and 70.60% in 2022. Lisdexamphetamine was the second most common in 2022, where 24.03% redeemed a prescription.

Limitations

Incidence and prevalence were calculated specifically for the Danish population and may not be directly generalizable to other countries.

Conclusions

The prevalence of ADHD has consistently increased throughout the past two decades. The main contribution to this increase is the ADHD incidence in females, especially young females in the most recent years 2020–2022. Methylphenidate was consistently the most common ADHD drug prescribed, though lisdexamphetamine use has increased in recent years.

导读：神经发育障碍注意缺陷/多动障碍（ADHD）的患病率和发病率上升已经在全球范围内进行了报道，丹麦此前也进行了估计。然而，方法上的差异阻碍了基于已发表文献对ADHD时间演变的评估。本研究的目的是持续计算2000年至2022年丹麦ADHD的年患病率和发病率以及ADHD药物的使用情况。方法：我们使用覆盖整个丹麦人口的登记数据进行了一项开放队列研究。我们将ADHD定义为医院诊断为ADHD (ICD-10: F90.0, F90.1, F90.8，或F98.8)，或已获得ADHD药物处方。结果：本组共7748837人，ADHD发生率为2.52%，其中男性占58.33%。ADHD的患病率从2000年的0.10%上升到2022年的3.03%。具体到18-27岁人群，2022年男性患病率为8.16%，女性患病率为6.12%。在同一年龄组中，女性发病率在2022年达到1.10%的峰值，而男性发病率在6-18岁之间一直最高，在2022年达到0.94%的峰值。人群中使用ADHD药物的总人数也有所增加。2000年有97.58%的ADHD服药患者使用哌甲酯，2022年为70.60%。里斯地安非他明在2022年是第二常见的，24.03%的人赎回了处方。局限性：发病率和流行率是专门为丹麦人口计算的，可能不能直接推广到其他国家。结论：在过去的二十年中，ADHD的患病率持续上升。这一增长的主要原因是近年来（2020-2022年）女性，特别是年轻女性的ADHD发病率。哌醋甲酯一直是最常见的ADHD药物，尽管近年来利地安非他明的使用有所增加。

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引用次数: 0

Is There Solid Evidence to Corroborate the Augmentation With Prazosin in Depression With Trauma? 是否有确凿的证据证实哌唑嗪对创伤性抑郁症的增强作用？

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-27 DOI: 10.1111/acps.13807

Victor Domingueti Vallim Fonseca, Letícia Braga Martins, Luísa Weber Bisol, Fabio Gomes de Matos e Souza

引用次数: 0

Comment on “A Systematic Review and Meta-Analysis of the Association Between Childhood Maltreatment and Adult Depression” 对“儿童虐待与成人抑郁关系的系统回顾和meta分析”的评论。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-24 DOI: 10.1111/acps.13805

Shubham Kumar, Rachana Mehta, Ranjana Sah

引用次数: 0

The Role of Antipsychotics and Mood Stabilizers in Preventing Sickness Absence Among Employed Individuals With Bipolar Disorder: A Nationwide Register-Based Study 抗精神病药物和情绪稳定剂在预防双相情感障碍患者缺勤中的作用：一项全国性的基于登记的研究。

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica

Pub Date : 2025-03-23 DOI: 10.1111/acps.13806

Minna Holm, Antti Tanskanen, Jari Tiihonen, Heidi Taipale

Introduction

Medication use may significantly affect work ability in bipolar disorder, but this area has been largely overlooked in research. We aimed to investigate how specific mood stabilizer and antipsychotic agents are associated with the risk of sickness absence among employed individuals with bipolar disorder.

Methods

We identified a nationwide cohort of 22,408 employed individuals with bipolar disorder, including 10,000 first-episode cases, and followed them from 2005 to 2018 through the nationwide administrative registers. The risk of sickness absence was analyzed using within-individual Cox regression where each person serves as their own control to eliminate selection bias.

Results

In the whole cohort, the monotherapies of lithium (HR = 0.75, 95% CI = 0.66–0.84), valproate (HR = 0.77, 0.70–0.85), and lamotrigine (HR = 0.87, 0.80–0.95) were associated with a lower risk of sickness absence than nonuse of mood stabilizers. In contrast, pregabalin monotherapy was associated with an increased risk of sickness absence (HR = 1.63, 1.34–1.99). Of antipsychotics, olanzapine was associated with a lower risk of sickness absence (HR = 0.75, 0.66–0.86) than antipsychotic nonuse. In the first-episode sample, lithium (HR = 0.51, 0.41–0.64), valproate (HR = 0.63, 0.52–0.75), lamotrigine (HR = 0.79, 0.68–0.91), and olanzapine (HR = 0.69, 0.54–0.87) monotherapies were associated with a lower hazard of sickness absence than nonuse.

Conclusions

Mood stabilizers including lithium, valproate, and lamotrigine, as well as olanzapine, of antipsychotics may reduce the risk of sickness absence, particularly, in first-episode patients. These findings encourage the continuous use of these medications to support occupational functioning among people with bipolar disorder.

药物使用可能会显著影响双相情感障碍患者的工作能力，但这方面的研究在很大程度上被忽视了。我们的目的是调查特定的情绪稳定剂和抗精神病药物如何与双相情感障碍就业个体的缺勤风险相关。方法：我们在全国范围内确定了22,408名双相情感障碍患者的队列，包括10,000例首发病例，并从2005年到2018年通过全国行政登记对他们进行了跟踪。使用个体内Cox回归分析缺勤风险，其中每个人作为自己的对照以消除选择偏差。结果：在整个队列中，锂（HR = 0.75, 95% CI = 0.66-0.84）、丙戊酸盐（HR = 0.77, 0.70-0.85）和拉莫三嗪（HR = 0.87, 0.80-0.95）的单一治疗与不使用情绪稳定剂的疾病缺席风险较低相关。相比之下，普瑞巴林单药治疗与缺勤风险增加相关（HR = 1.63, 1.34-1.99）。在抗精神病药物中，与未使用抗精神病药物相比，奥氮平与较低的疾病缺勤风险相关（HR = 0.75, 0.66-0.86）。在首次发作的样本中，锂（HR = 0.51, 0.41-0.64）、丙戊酸盐（HR = 0.63, 0.52-0.75）、拉莫三嗪（HR = 0.79, 0.68-0.91）和奥氮平（HR = 0.69, 0.54-0.87）单一疗法与缺勤的风险较低相关。结论：情绪稳定剂包括锂、丙戊酸盐、拉莫三嗪和奥氮平，抗精神病药物可以降低疾病缺勤的风险，特别是在首发患者中。这些发现鼓励持续使用这些药物来支持双相情感障碍患者的职业功能。

{"title":"The Role of Antipsychotics and Mood Stabilizers in Preventing Sickness Absence Among Employed Individuals With Bipolar Disorder: A Nationwide Register-Based Study","authors":"Minna Holm, Antti Tanskanen, Jari Tiihonen, Heidi Taipale","doi":"10.1111/acps.13806","DOIUrl":"10.1111/acps.13806","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medication use may significantly affect work ability in bipolar disorder, but this area has been largely overlooked in research. We aimed to investigate how specific mood stabilizer and antipsychotic agents are associated with the risk of sickness absence among employed individuals with bipolar disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified a nationwide cohort of 22,408 employed individuals with bipolar disorder, including 10,000 first-episode cases, and followed them from 2005 to 2018 through the nationwide administrative registers. The risk of sickness absence was analyzed using within-individual Cox regression where each person serves as their own control to eliminate selection bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the whole cohort, the monotherapies of lithium (HR = 0.75, 95% CI = 0.66–0.84), valproate (HR = 0.77, 0.70–0.85), and lamotrigine (HR = 0.87, 0.80–0.95) were associated with a lower risk of sickness absence than nonuse of mood stabilizers. In contrast, pregabalin monotherapy was associated with an increased risk of sickness absence (HR = 1.63, 1.34–1.99). Of antipsychotics, olanzapine was associated with a lower risk of sickness absence (HR = 0.75, 0.66–0.86) than antipsychotic nonuse. In the first-episode sample, lithium (HR = 0.51, 0.41–0.64), valproate (HR = 0.63, 0.52–0.75), lamotrigine (HR = 0.79, 0.68–0.91), and olanzapine (HR = 0.69, 0.54–0.87) monotherapies were associated with a lower hazard of sickness absence than nonuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mood stabilizers including lithium, valproate, and lamotrigine, as well as olanzapine, of antipsychotics may reduce the risk of sickness absence, particularly, in first-episode patients. These findings encourage the continuous use of these medications to support occupational functioning among people with bipolar disorder.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 2","pages":"104-111"},"PeriodicalIF":5.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690445","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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