Current Opinion in Psychiatry最新文献

Purpose of review: Obesity and related metabolic disorders are extremely common in psychiatric patients, particularly in those with schizophrenia. Elucidating this link's neurobiology may inform clinicians and researchers of rational therapeutic approaches necessary to optimize clinical outcomes.

Recent findings: Current literature highlights the pivotal role of the inflammation-oxidative stress-insulin resistance loop in the pathophysiology of both metabolic and neuropsychiatric disorders. The concept of 'diabetophrenia' is put forward to highlight the overlapping neurobiological mechanisms underlying metabolic dysfunction and schizophrenia symptoms. Innovative treatments, including the combination of xanomeline with trospium and incretin-based medicines, demonstrate encouraging potential in addressing such complex health challenges.

Summary: The nuanced dynamics of chronic inflammation and psychiatric symptomatology underscore the significance of addressing both metabolic and mental health factors in a cohesive fashion while considering unique psychosocial contexts, dietary preferences, and lifestyle choices. A multidisciplinary strategy is essential for incorporating counseling, dietary interventions, behavioral therapies, and pharmacotherapy into the management of schizophrenia. The ensuing enhanced collaboration among healthcare professionals may render obsolete the prevailing siloed conceptualizations of mental disorders, opening new vistas for generating synergistic insights into the mind-body systems and leading to improved health and quality of life for patients with schizophrenia and other psychiatric conditions.

Purpose of review: This review of the latest literature aims to underscore some unique characteristics of schizophrenia in women and to explore the role of hormonal fluctuations and life-stage stressors in its pathogenesis and management. It summarizes the emerging evidence-based recommendations on biological and psychosocial interventions, with the goal to raise awareness of some gender-specific issues and the ultimate intent to optimize outcomes for this patient population.

Recent findings: Schizophrenia affects men and women differently due to gender-specific biological, psychological, social, and cultural factors. Hormonal changes through the woman's reproductive life are associated with differences in disease expression, response to treatment, and treatment adjustments.

Summary: Schizophrenia is a chronic and serious mental illness associated with significant personal and societal burden and with important sexual differences in presentation, course, and management, attributed at least in part to hormonal changes and other factors (e.g. medication compliance, drug interactions, social and cultural characteristics). Periods of high hormonal flux, such as pregnancy, postpartum, and the menopause transition, pose additional challenges concerning psychiatric stability and treatment efficacy and safety. Becoming familiar with important gender-specific characteristics including biological, psychological and sociocultural determinants can lead to adjustments in management and, ultimately, to improved outcomes.

Purpose of review: Using the ecological public health framework, this study aims to systematically review the risk of illicit drug use and its associated negative health outcomes relating to urbanization.

Recent findings: Previous studies have indicated that urbanization associated with increased population density drives segregation of vulnerable communities of low socioeconomic status (SES). Marginalized individuals in segregated communities have increased risk of poor mental health and illicit drug use.

Summary: The results indicated that urban-specific environmental risk factors, individual characteristics and level of social support all influenced risk of drug use, substance use disorder (SUD), overdose, and drug-use associated death. Urban environmental risk factors of economic disparity, marginalization and barriers in accessing healthcare and negative individual characteristics of low education, low income and comorbid diagnosis of mental illness significantly increased risk of drug use. In contrast, better social support reduced the risk of drug use.

Purpose of review: The debate over renaming schizophrenia has gained international momentum, driven by concerns about stigma and scientific accuracy. This review examines the arguments for and against renaming schizophrenia, highlighting research data from the US and international efforts.

Recent findings: Proponents argue that the current term perpetuates stigma, is scientifically outdated, and that stakeholders, including those with lived experience, favor a name change. Opponents, however, caution that renaming might not reduce stigma and could complicate access to care. Stigma associated with schizophrenia leads to significant discrimination in healthcare, employment, and social interactions. Moreover, the term inaccurately suggests a 'split' in the brain, contributing to public misconceptions. Survey data from various countries reveal substantial support for renaming, with some evidence suggesting that new terms can reduce stigma and improve treatment engagement. Historical precedents, such as the renaming of multiple personality disorder to dissociative identity disorder, show that such changes can occur without disrupting care.

Summary: The review concludes that while renaming schizophrenia could align the term with contemporary science and reduce stigma, a systematic, consensus-building approach involving diverse stakeholders is essential. Future steps should focus on finding an appropriate name that reflects the illness's core aspects and ensures optimal care.

Purpose of review: This review explores the intersection of urbanization, stress, inflammation, diet, lifestyle changes, and digital evolution as key factors influencing depression, emphasizing the necessity for integrative and evolutionary perspectives in mental health and intervention.

Recent findings: Epidemiological studies reveal a dramatic increase in common mental disorders, particularly depression, alongside parallel increases in suicide, unemployment, and divorce rates. Evolutionary perspectives suggest that mechanisms once advantageous for survival, such as stress responses and inflammatory processes, may contribute to mental health challenges in modern urban environments. Moreover, the mental health crisis among generation Z underscores the impact of digital evolution, where the shift from play-based to phone-based childhood contributes significantly to rising depression rates. Recent research highlights the significant role of omega-3 fatty acids, circadian rhythm regulation, mindfulness, and anti-inflammatory lifestyle interventions in mitigating depressive symptoms.

Summary: The interplay between our evolutionary heritage and rapid societal changes has created a "symphony" of factors contributing to depression. Understanding these evolutionary mismatches in stress responses, inflammatory processes, dietary shifts, circadian disruptions, and digitalization provides new insights into the etiology of depression. This holistic approach, conceptualized as "harmonizing the inner orchestra," offers promising avenues for prevention and treatment strategies that address the multifaceted nature of depression in our modern world.

Purpose of review: Land-expropriated farmers have become a large and rapidly growing subpopulation in recent decades due to China's unprecedented industrialization and urbanization. Land appropriation has detrimental effects on the mental health of land-lost farmers. However, existing studies have conflicting findings on the severity and types of psychological symptoms among land-lost farmers compared to the general population. This review presents a meta-analysis of cross-sectional studies that assessed the psychological symptoms of land-lost farmers using the Symptom Checklist-90-Revised (SCL-90-R).

Recent findings: Major Chinese- and English-language databases were searched and eight eligible studies reporting the SCL-90-R subscale scores and standard deviations among Chinese land-lost farmers were included. Meta-analysis results showed that, among land-lost farmers, phobia was the most prominent psychological symptom (Cohen's d  = 0.55), followed by depression ( d  = 0.42), somatization ( d  = 0.38), anxiety ( d  = 0.35), interpersonal sensitivity ( d  = 0.29), and hostility ( d  = 0.25).

Summary: Chinese land-lost farmers exhibit several significant psychological symptoms, including phobia, depression, somatization, anxiety, interpersonal sensitivity, and hostility. These data suggest a pressing need to integrate mental health support into existing social services and policies aimed at assisting land-lost farmers.

Purpose of review: There are few studies investigating the effects of urbanization on various anxiety-related conditions in specific population subgroups. This review aims to examine the effects of urbanization through the lens of population subgroups as well as anxiety disorder subtypes.

Recent findings: There was more consistent evidence suggesting that those of a younger age group and from disadvantaged backgrounds (such as lower socioeconomic status, refugee status) may be more vulnerable to posttraumatic stress disorder (PTSD). When we examined the relationship between urbanization and anxiety disorder subtype, the results were largely mixed, with some evidence for the positive association between urbanization and PTSD. Many of the recent studies had been conducted in the context of the recent coronavirus disease 2019 (COVID-19) pandemic.

Summary: The association between urbanicity and anxiety-related disorders in the various subgroups can be influenced by socio-demographic factors. Interventions and policies that aim to ameliorate the effects of urbanicity would need to identify vulnerable individuals early based on social or environmental factors. Given that the short and long-term psychological sequelae of the recent COVID-19 pandemic are still being evaluated, the inter-relationships between urbanization, external factors and specific anxiety disorders await further delineation.

Purpose of review: This review examines the literature associating cannabis with schizophrenia, glutamate dysregulation in schizophrenia, and cannabis involvement in glutamate pathways. Cannabis use is widespread among adolescents world-wide and is sold legally in many countries for recreational use in a variety of forms. Most people use it without lasting effects, but a portion of individuals have negative reactions that manifest in acute psychotic symptoms, and in some, symptoms continue even after the use of cannabis has ceased. To date, there is a huge gap in our understanding of why this occurs.

Recent findings: Recent studies have focused on abnormalities in the glutamate pathway in schizophrenia, the effect of cannabis on the glutamate system, and the role of glutamate in the brain Default Mode Network.

Summary: Given these observations, we hypothesize that perturbance of glutamate neuronal connectivity by cannabis in the brains of individuals genetically at high risk for psychosis will initiate a schizophrenia-like psychosis. Future studies may tie together these diverse observations by combining magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging (fMRI) of the default resting state network in patients with new onset schizophrenia who do and do not use cannabis compared with nonpsychotic individuals who do and do not use cannabis.