European Archives of Psychiatry and Clinical Neuroscience最新文献

Background: Studies have reported the retinoid X receptor (RXR)-peroxisome proliferator-activated receptor-γ (PPAR-γ) axis, a heterodimeric nuclear receptor complex regulating synaptic plasticity and neuroinflammation, in neurodevelopment, with emerging evidence suggesting its disruption contributes to cognitive impairments akin to those in attention deficit hyperactivity disorder (ADHD).

Methods: This study included 104 adolescents with ADHD and 87 age-matched neurotypical adolescents. All participants completed working memory and go/no-go tasks. Clinical symptoms were assessed using the Swanson, Nolan, and Pelham IV scale and the Child Behavior Checklist Dysregulation Profile. Fasting serum levels of RXR-α, PPAR-γ, and PPAR-γ coactivator 1α were quantified via enzyme-linked immunosorbent assay.

Results: Generalized linear models adjusted for demographic characteristics, ADHD medications, and clinical symptoms revealed that adolescents with ADHD had reduced RXR-α levels (p = 0.001; Cohen's d = 0.47) compared with neurotypical adolescents. No significant between-group difference was noted in the level of PPAR-γ or PPAR-γ coactivator A. Furthermore, RXR-α levels negatively associated with the mean reaction time in the go/no-go task (β = -0.001; Wald χ2 = 0.475; p = 0.029).

Conclusion: To the best of our knowledge, this study is the first to demonstrate reduced peripheral RXR-α levels in human adolescents with ADHD, independent of medication status and symptom severity, extending preclinical retinoid signaling evidence. Further investigation is required to elucidate the neuromechanisms linking ADHD to the RXR-PPAR-γ axis.

Objective: Motor stereotypies (MS), emotional dysregulation (ED), and altered sensory reactivity (SENS) are highly prevalent in children with autism spectrum disorder (ASD). Various studies suggest a relationship among these variables. This study aimed to examine the relationship between ED and sensory patterns and to analyse their combined influence on MS in adolescents and adults with ASD.

Methods: In total, 97 adolescents and adults with ASD were evaluated using the Stereotyped Behavior Scale, the Emotion Dysregulation Inventory, and the Adolescent/Adult Sensory Profile. Correlation coefficients and multiple linear regression models were used to analyse the data.

Results: In the multivariate analysis, age, sensory hyporeactivity, and sensory seeking together with ED, explained MS frequency. Conversely, sensory hypo- and hiperreactivity, and ED explained MS severity. ED was correlated with both sensory hypo-/hyperreactivity, but not with sensory seeking. This relationship influenced the effect of ED on MS frequency and severity in regression models both with and without sensory variables. Intellectual disability did not demonstrate a significant influence on MS. The presence of psychopathological comorbidity had a partial influence-greater than that of ED-on MS severity.

Conclusion: The relationship between MS, ED, and SENS persists in adolescents and adults with ASD, varying according to the sensory patterns analysed. These findings support the importance of studying each pattern separately. The relationship between ED and sensory hypo-/hyperreactivity modulates the effect of ED on MS. Age and psychopathological comorbidity also influenced the results. The factors influencing the frequency and severity of motor stereotypies diverge. These results could improve our comprehension of MS, thereby facilitating more appropriate MS treatment strategies.

Background: Schizophrenia and bipolar disorder significantly impair daily functioning and quality of life. Effective treatment monitoring requires tools assessing both clinical symptoms and everyday impairment.

Aim: This cross-sectional study explored relationships between symptoms, side effects, and functioning using clinician-rated and patient-reported measures. We examined whether the Glasgow Antipsychotic Side-Effect Scale (GASS), a patient-reported outcome measure (PROM), is associated with disability and quality of life comparably to the clinician-administered Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale.

Methods: We recruited 100 individuals with schizophrenia spectrum or bipolar disorders receiving antipsychotic treatment. Linear regressions and network analyses were conducted. Linear regressions assessed the association between side effects, disability (World Health Organization Disability Assessment Schedule, WHODAS) and quality of life (EuroQol 5-Dimension scale, EQ-5D). Network analyses were conducted to explore the interplay between side effects, disability, quality of life and symptoms, the latter assessed using the Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS), and Montgomery-Åsberg Depression Rating Scale (MADRS).

Results: Side effects assessed with GASS and UKU significantly impacted disability (GASS: p < .001, 95% CI [0.274; 0.635]; UKU: p < .001, 95% CI [0.313; 1.021]) and reduced quality of life (GASS: p < .001, 95% CI [-1.391; -0.511]; UKU: p < .001, 95% CI [-3.176; -1.668]). Network analysis identified depressive symptoms as central in the UKU network and autonomic side effects as central in the GASS network.

Conclusion: GASS total and subgroup scores showed comparable associations with disability and quality of life as UKU. Integrating both perspectives enables comprehensive monitoring and patient-centred care.

Objective: The triglyceride-glucose (TyG) index, linked to insulin resistance (IR), is implicated in depression, but its association with anxiety in major depressive disorder (MDD) is unclear. Subclinical hypothyroidism (SCH) is independently associated with metabolic issues and anxiety in MDD. This study aimed to (1) validate the TyG-anxiety link in first-episode, drug-naïve (FEDN) MDD patients and (2) explore SCH's interactive role.

Methods: This cross-sectional study involved 1,654 FEDN MDD patients. Demographics, clinical data, and biochemical markers (including the TyG index) were collected. Depression and anxiety severity were assessed using HAMD-17 and HAMA-14 scales. Multivariable linear regression evaluated the TyG-anxiety association. Stratified analyses by SCH status and interaction tests were conducted.

Results: Of 1,654 MDD patients, 79.6% (1,316) had anxiety distress (HAMA-14 ≥ 18). In a fully adjusted model, each 1-unit TyG index increase was associated with a 0.67-point higher anxiety score (β = 0.67, 95% CI: 0.33-1.01). Patients in the highest TyG quintile (Q5: 9.42-10.27) showed a 0.75-point increase versus the lowest quintile (Q1: 6.64-8.59) (P < 0.05). This association was significant in patients with SCH (β = 1.15, 95% CI: 0.68-1.61), not in those without SCH (β = 0.05, 95% CI: -0.44-0.53) (P for interaction<0.05).

Conclusions: The TyG index is independently associated with anxiety symptoms in FEDN MDD patients, particularly in those with comorbid SCH. This suggests that the interaction between thyroid function and metabolism is associated with anxiety symptoms, highlighting a potential biological interplay that warrants further investigation. Clinicians should pay attention to anxiety levels in patients with MDD who also present with metabolic disturbances and SCH. Future longitudinal and basic studies are needed to confirm causality and mechanisms.

Aim: Schizophrenia is a chronic brain disorder with cognitive impairment as one of the cardinal manifestations. White matter organization abnormalities shown on brain imaging were also documented in patients with schizophrenia. However, when and how the cognitive impairment, the white matter organization abnormalities and their correlation occur and evolve throughout the illness course of schizophrenia remain undetermined. We aimed to show cognitive impairment and white matter organization abnormalities across different stages of schizophrenia and the association between them.

Methods: We collected 4 groups of participants: 40 individuals with illness duration of schizophrenia below 5 years, 36 individuals with illness duration of schizophrenia around 15 years, 39 individuals with illness duration of schizophrenia above 25 years, and 78 healthy controls. All participants underwent 3 cognitive tests (Wisconsin Card Sorting Test, Digit Span, Mini-Mental Status Examination) and 2 diffusion tensor imaging analyses of white matter (fractional anisotropy and graph theoretical analysis).

Results: We found cognitive impairment aggravated from early stage to the third decade of illness in schizophrenia. The associated white matter structural abnormalities had two steps of change: alteration in network organization occurred at early stage of schizophrenia, and then reduction in white matter tract integrity ensued from the second decade of the illness. The white matter integrity reduction was associated with cognitive impairment.

Conclusion: By using groups of participants with different illness duration, we found cognitive impairment and white matter organization abnormalities and their association across a three-decade illness course in schizophrenia. Our findings suggested active cognitive rehabilitation to patients with schizophrenia throughout the course of illness may be warranted.

The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) demonstrated excellent results in its original study, with a sensitivity of 97% and a specificity of 100% (Ritvo et al. in J Autism Dev Disord 41:1076-1089, 2011). As a result, it was included in the National Institute for Health and Care Excellence (NICE) guidelines (Recommendations | Autism spectrum disorder in adults: diagnosis and management | Guidance | NICE, 2022). The questionnaire includes 80 questions across four subcategories (language, social relatedness, circumscribed interests, sensory motor). So far, the subcategory sensory motor has not been addressed in most available instruments, despite being part of the diagnostic criteria specified in DSM-5 (Falkai et al., in Diagnostisches Und Statistisches Manual Psychischer Störungen DSM-5. Hogrefe, 2015) and ICD-11 (ICD-11 for Mortality and Morbidity Statistics, 2022). In our validation study, we tested a translated German version of the questionnaire in 299 individuals (110 persons with ASD according to ICD-10 F84.0, F84.5, 64 persons with an primary mental disorders (PMD), 125 persons with no disorders). To enhance the practical use of the instrument in clinical everyday practice, the questionnaire was completed by the participants without the presence of a clinician-unlike the original study. Psychiatric diagnoses were established following the highest standards, and psychometric properties were calculated using established protocols. The German version of the RADS-R yielded very good results, with a high sensitivity of 92.5% and a high specificity of 93.6%. The area under the curve (AUC = 0.976), indicates a high quality and discriminatory power of RADS-R. Furthermore, the ROC curve analysis showed that the optimal threshold to distinguish between the ASD and non-ASD groups in the German version of the RAADS-R is a score of 81. In comparison to the RADS-R, the co-administered instruments Social Responsiveness Scale (SRS), Autism Spectrum Quotient (AQ), and Empathy Quotient (EQ) each showed slightly better specificity but worse sensitivity in this sample.The study included individuals already diagnosed with ASD according to ICD-10 (F84.0, F84.5), with or without an primary mental disorders, preventing us from identifying the influence of comorbidities on the RADS-R results. In addition, a self-report questionnaire has generally only limited objectivity and may allow for false representation of the symptoms. The RADS-R compares well with other questionnaires and can provide valuable additional information. It could turn out to be a helpful diagnostic tool for patients in Germany. We propose naming the German version RADS-R (Ritvo Autism Diagnostic Scale - rRevised) to reflect the change in terminology.