Current Opinion in Psychiatry最新文献

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: To highlight recent findings on the prevalence and risk and protective factors for dementia in Indigenous Peoples, who are disproportionately affected by health inequities driven by social determinants of health and historical injustices. With increasing numbers of Indigenous individuals entering older age, there is a growing need for research to better understand dementia and opportunities for prevention in Indigenous Peoples.

Recent findings: Recent studies highlight a wide range of dementia prevalence across Indigenous Peoples, with estimates varying significantly by methodology, socio-cultural context, and region with stark gaps in regional representation. Studies suggested that Indigenous Peoples show distinct profiles of dementia risk factors, including higher rates of cardiovascular disease, lower educational attainment, and socioeconomic disadvantage. However, traditional lifestyles, strong social ties, and culturally grounded practices are suggested to offer protective effects against cognitive decline.

Summary: Despite growing research attention, significant limitations remain in understanding dementia in Indigenous Peoples. The available evidence points to the need for culturally sensitive approaches in research and dementia prevention, as well as greater consideration of the social and environmental factors shaping brain health. Future research should aim to incorporate Indigenous knowledge systems and address the social determinants of dementia risk in Indigenous Peoples.

Purpose of review: Over the last quarter century, the clinical evidence surrounding the use of electroconvulsive therapy (ECT) in individuals with autism spectrum disorder (ASD) has expanded. This review provides the most up-to-date findings on the usage of ECT in ASD and discusses these results within the historical context and direct patient care experience.

Recent findings: ECT is typically implemented for psychotropic-refractory catatonic, affective, psychotic, and combined pathology for individuals across the lifespan. Although highly stigmatized, ECT is well tolerated, efficacious, and potentially lifesaving for select individuals. A case presentation of an individual with autism as well as a summary of legal restrictions hampering his ECT access is presented.

Summary: ECT is increasingly used in individuals with ASD who present with a wide range of ECT-responsive psychopathology, as well as repetitive self-injury and late, autistic-like regression for which no cause is found. ECT is well tolerated and offers real hope for many ASD individuals with devastating, treatment-refractory conditions.

Purpose of review: Prader-Willi (PWS) and Angelman (AS) syndromes arise from errors in 15q11-q13 imprinting. This review describes recent advances in genomics and how these expand our understanding of these rare disorders, guiding treatment strategies to improve patient outcomes.

Recent findings: PWS features include severe infantile hypotonia, failure to thrive, hypogonadism, developmental delay, behavioral and psychiatric features, hyperphagia, and morbid obesity, if unmanaged. AS presents severe intellectual disability, motor dysfunction, seizures, absent speech, and a characteristic happy demeanor. Standard-of-care testing involves SNRPN promoter methylation, chromosomal microarrays and genomic studies for individuals presenting these features. These tests identify syndromic-specific DNA methylation patterns and molecular genetic classes responsible for disease etiology. This review provides an update on studies of genotype-phenotype relationships and novel genomic technologies used for diagnostic purposes.

Summary: We give an overview and update on the genetics and underlying mechanisms associated with symptoms and potential treatments with focus on features reported to be different between specific molecular genetic classes. The review also describes laboratory testing methods for screening and diagnosis of these imprinting disorders with implications for clinical practice.

Purpose of review: Using advanced bibliometric analysis, we systematically mapped the most current literature on urban air pollution and neurodevelopmental conditions to identify key patterns and associations. Here, we review the findings from the broader literature by discussing a distilled, validated subset of 44 representative studies.

Recent findings: Literature highlights a complex relationship between environmental toxins, neurodevelopmental disorders in children, and neurobehavioral pathways involving oxidative stress, neuroinflammation, and protein aggregation. Chronic prenatal and postnatal exposure to airborne pollutants - such as particulate matter and heavy metals - may contribute to early formation of amyloid plaques through preadolescence. These processes may compromise synaptic plasticity and neural integrity, which can progressively induce cognitive, emotional, and behavioral dysregulation, sharing some pathological features traditionally associated with adult neurodegenerative diseases.

Summary: The interactions between air pollution exposure levels, developmental timing, and factors such as genetic vulnerability associated with neurodevelopmental disorders are still undetermined. However, accelerated neurodegenerative processes leading to cognitive decline and suboptimal mental health in children and adolescents seem most likely linked with pollutants penetrating the blood-brain barrier, and inducing oxidative stress and neuroinflammation. Urgent precautionary action might reduce environmental exposures during critical early developmental periods, thereby safeguarding children's cognitive function and mental health.

Purpose of review: Recent literature suggests a potential causal link between metabolic bariatric surgery (MBS) and an increased risk of eating disorders. However, the available literature offers unclear results regarding the definition of eating problems among MBS patients, their potential impact on weight outcomes, and the efficacy of adjunctive treatment.

Recent findings: Although eating disorders may be rare phenomena after surgery, disordered eating behaviors are more common and tend to be more consistently associated with suboptimal weight loss. There also appear to be clear problems when using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria to assess eating disorders among MBS patients, particularly for restrictive eating, binge-eating episodes, and the core psychopathology of eating disorders. Finally, preoperative interventions appear to offer effects limited to the presurgery period, and the evidence for the efficacy of postoperative interventions remains limited. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer promising benefits for weight loss and the treatment of binge-eating problems, but their potential risks must be carefully managed.

Summary: Recognizing the diverse presentations of these problems among individuals undergoing MBS is crucial. Clinical attention should focus on intensive specialized care during the postoperative period for those who develop eating-related problems.

Purpose of review: The Arab world is dealing with modernization and sociocultural changes both associated with eating disorders. The present review provides an update of 'Eating disorders in the Arab world: a literature review', which was published in 2020.

Recent findings: There are 22 recent epidemiological studies on eating disorders in five different countries in the Arab world. A large-scale national mental health survey reported a 12-month eating disorder prevalence of 3.2% and an eating disorder lifetime prevalence of 6.1%. Binge-eating disorder was the most common eating disorder (12-month prevalence = 2.1%, lifetime prevalence = 2.6%), 1.6% was at high risk for binge-eating disorder. Overall, between 23.8 and 34.8% was at high risk for any eating disorder. Body-shape dissatisfaction, a high BMI and separated/widowed/single marital status were associated with eating disorder pathology.

Summary: Although there is still a lack of studies compared to the western world, the number of epidemiological studies on eating disorders in the Arab world is growing and there is an increase in studies using appropriate assessment-tools and norms. It is recommended to offer specialized treatment and to implement preventive programs.

Purpose of review: Research on early intervention for eating disorders has started to gain traction and examples of this in practice are increasing. This review summarizes findings over the past 3 years, focusing on the clinical effectiveness of early intervention in practice and the barriers and facilitators to its implementation.

Recent findings: Recent developments in early intervention for eating disorders can be divided into three broad themes: research that has examined the efficacy of early intervention pathways in practice, research that has informed understanding of the target patient groups of early intervention (via clinical staging models, e.g.), and research that has suggested new ways to progress early intervention, towards becoming a standard part of best practice care.

Summary: Early intervention pathways have shown promising clinical outcomes and are viewed positively by patients, clinicians and other stakeholders. However, more robust trials of their efficacy, effectiveness and cost-effectiveness are needed. Additionally, barriers to early intervention have been identified (e.g. delayed help-seeking); research must now develop and evaluate strategies to address these. Finally, the early intervention models in practice are underpinned partly by clinical staging models for eating disorders, which require further development, especially for eating disorders other than anorexia nervosa.

Purpose of review: Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers.

Recent findings: Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes.

Summary: Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.

Purpose of review: The incidence of eating disorders has increased worldwide. This narrative review gives an overview of research on etiology and risk factors of eating disorders published in 2022-2024.

Recent findings: Eating disorders arise from a complex set of risk factors. The recent increase in incidence of eating disorders can be linked to root causes that include sociocultural pressure to conform to unrealistic and gendered body ideals, rise in obesogenic environments, and the global COVID-19 pandemic. Recent studies have shown that screen time and social media intensify sociocultural pressure to look a certain way. Individual-specific risk factors also increase the likelihood of onset of eating disorders. These include sports, stressful and traumatic life events, family factors, and psychological factors, including disgust sensitivity, aversive experiences, low self-esteem, perfectionism, neuroticism, obsessive-compulsive and impulsive features, and emotional dysregulation. Preexisting mental health conditions, particularly anxiety, depression, and posttraumatic stress disorder, and neurodevelopmental conditions, such as autism and attention-deficit hyperactive disorder, are also associated with increased eating disorder risk. Genetic and biological factors contribute both to risk and resiliency.

Summary: The risk factors of eating disorders are well established. Future studies should focus on increasing resilience and preventive interventions.