Current Opinion in Psychiatry最新文献

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.

Purpose of review: Cognitive impairment in schizophrenia (SCZ) is very common and functionally relevant, being a consistent predictor of the ability to perform critical functional skills and real-world activities, such as residential independence, self-care, productive, and social activities. These impairments are not exclusive to individuals with SCZ; they are also observed in people with bipolar disorder and other mood disorders. Here, we review recent findings in the nature, determinants, and treatment of cognitive impairments with a focus on SCZ and linkage to other closely related conditions.

Recent findings: Recent studies have identified multiple levels of similarity in cognitive functioning across psychiatric conditions and identified a number of efficacious treatments. So much successful work has taken place in training-focused treatment domains that multiple meta-analyses have catalogued the level of gains, the predictors of gains, the optimal strategies, and the durability of improvement. There is also convincing evidence for the first time of pharmacological cognitive enhancement with a mechanism that is plausible for cross-diagnostic impact.

Summary: Clinicians need to consider cognitive functioning and not just in people with SCZ. Available treatments should be considered, including suggesting computerized cognitive and skills training across the full spectrum of conditions and the lifespan. Attending to new developments in pharmacological interventions will be critical, as there is at least one very promising candidate compound approved for the general treatment of SCZ with evidence of wide-ranging benefits. Other medications are in phase 2 and 3 trials and may be approved.

Purpose of review: Digital technology is beginning to revolutionize psychiatry. Virtual reality (VR) allows users to experience a virtual space through their three primary senses. In psychiatry, social skills training (SST), including role-play, has been introduced in occupational therapy to improve patients' social abilities. In face-to-face SST, the therapist's leadership skills and the patient's ability to deal with situations are necessary. VR could resolve such limitations. Herein, we introduce recent advances in VR for psychiatry.

Recent findings: The introduction of VR has improved the social skills of patients with schizophrenia, social anxiety, and autism spectrum disorder. We have introduced VR not only for psychiatric patients themselves but also for their family members to improve their skills in intervening with the patients, especially hard-to-reach patients such as hikikomori (social withdrawal). A pilot trial was conducted involving several family cases living with people with hikikomori, and this approach showed promising effectiveness.

Summary: VR has the potential to overcome the problems of conventional treatments by enabling experiential learning. In the future, VR is expected to support not only patients with mental disorders but also to improve the skills of therapists and caregivers, including family members. Empirical research through industry-academia collaboration is desirable for spreading VR-based interventions in psychiatry.

Purpose of review: Worldwide efforts continue to unravel the complex pathological pathways that lead to Alzheimer's disease. The gut-brain-microbiome axis, a communication pathway between the gut, brain and microorganisms, is emerging as a potential mechanism involved in Alzheimer's disease pathogenesis. While the gut microbiome's role in Alzheimer's disease has gained significant attention, the brain microbiome remains relatively unexplored. This review summarizes the latest research on the brain microbiome in Alzheimer's disease.

Recent findings: In the past 4 years, four out of five studies have found bacteria, such as Streptococcus pneumoniae , in postmortem samples of both control and Alzheimer's disease brains, supporting the idea that the brain is not a sterile environment. Two studies report the overabundance of several bacterial phyla, including Proteobacteria and Actinomycetes, in postmortem Alzheimer's disease brains versus controls. One study reported the presence of Borrelia burgdorferi in a subset of Alzheimer's disease cases compared to controls.

Summary: Limitations and challenges persist in studying the brain microbiome, including the lack of standardized assays and data analysis methods, small sample sizes, and inconsistent use of controls for environmental microbial contamination during sample processing. Well designed studies that employ reproducible and rigorous methods are required to elucidate whether microbes are involved in the pathogenesis of Alzheimer's disease.

Purpose of review: The prevalence of internet addiction among university students has been extensively studied worldwide, however, the findings have been mixed. This meta-analysis aimed to examine the global prevalence of internet addiction in university students and identify its potential moderators.

Recent findings: A total of 101 eligible studies, comprising 128020 participants across 38 countries and territories, were included. The pooled global prevalence of internet addiction among university students was 41.84% [95% confidence interval (95% CI): 35.89-48.02]. Significant differences in the prevalence were observed across different income levels, regions, periods of COVID-19 pandemic, and cut-off values of the Internet Addiction Test (IAT). Sample size was negatively associated with internet addiction prevalence, while depression prevalence was positively associated with internet addiction prevalence. Male students had a significantly higher risk of internet addiction compared to female students [pooled odd ratio (OR): 1.32, 95% CI: 1.19-1.46].

Summary: This meta-analysis found that the prevalence of internet addiction was high among university students, which has increased since the COVID-19 pandemic. Screening and intervention measures to address internet addiction should prioritize students with an increased risk including male students, those from lower-income regions and those with depression.

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: There has been growing interest in the role of biofluid biomarkers to aid the diagnosis of dementia in older people. However, less attention has been given to younger people who have dementia (young-onset dementia), who frequently experience misdiagnoses of primary psychiatric disorders diagnostic delay and challenges accessing appropriate care.

Recent findings: We describe 12 studies from the previous 2 years of which the majority have investigated the role of neurofilament light chain protein (NfL) in blood and cerebrospinal fluid in distinguishing young-onset dementia from primary psychiatric disorders. Synaptic and astrocytic biomarkers were also investigated. Sample sizes ranged from n = 46 to n = 999 and studies were mostly from Australia and the Netherlands.

Summary: The major finding from this review was that NfL has very high sensitivity and specificity in differentiating a range of young-onset dementias (Alzheimer's dementia, behavioural-variant frontotemporal dementia) from PPD (schizophrenia, bipolar affective and major depressive disorders). NfL is easily accessible via the blood, so there is significant potential that a blood test could be available to make this dichotomisation. Further research is required to support clinical translation such as changes of NfL with disease progression and standardising analytic techniques.

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, microarray and genomic analyses for individuals presenting with 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 diagnosis of these imprinting disorders with implications for clinical practice.