European Archives of Psychiatry and Clinical Neuroscience最新文献

Examining psychiatric antecedents and help-seeking behavior for people with First Episode Psychosis (FEP) could help understand determinants for timely care pathways, decrease the "Duration of Untreated Psychosis" (DUP), and consequently improve their prognosis. The aims of this study were: (1) to calculate the proportion of FEP participants with previous contact with mental healthcare services recruited within a specialized "Early Intervention in Psychosis" service, and (2) to longitudinally compare sociodemographic, clinical, and treatment parameters between FEP patients with and without psychiatric antecedents across a 2-year follow-up period. All participants (aged 12-35 years) were enrolled within the "Parma Early Psychosis" (Pr-EP) program. At baseline, they completed the Health of the Nation Outcome Scale (HoNOS). A mixed-design ANOVA and a Kaplan-Meier survival analysis were used. Of the 489 FEP participants, 204 (41.7%) patients had prior contact with mental health services. In 83% of cases, a care discontinuity was observed. Main psychiatric antecedents at entry were personality disorders (32.8%), anxious-depressive disorder (28.9%), conduct disorder (16.2%), and learning disorder (9.8%). FEP subjects with antecedents were more likely to receive a diagnosis of schizophrenia at baseline. Having previous contact with psychiatric services resulted to be a predictor of poorer clinical and functional outcome. It is very important to carefully monitor mental health suffering and related help-seeking-behavior in young patients typically manifested in their early 20s, especially in terms of psychosis prevention. Particular attention should also be given to service engagement as care continuity within adolescent-adult transition.

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often share multiple similar symptoms and are highly comorbid; however, the common and distinct brain neuroanatomy of these two diseases are unclear. The current study attempted to identify the overlapping and different gray matter volume (GMV) between AN and OCD. We conducted a voxel-wise meta-analysis of GMV using the latest Seed-based d Mapping with Permutation of Subject Images Toolbox (SDM-PSI) software. Compared to healthy controls, patients with AN showed reduced GMV in supplementary motor areas, median cingulate cortices, the left cerebellum, right Rolandic operculum (RO), right insula, right superior temporal gyrus (STG), and right precuneus, while OCD patients were characterized by low GMV in the right insula, STG, RO, and inferior frontal gyrus (IFG). The conjunctional analysis indicated that these two disorders have overlapping structural abnormalities in the right insula, STG, RO and IFG. No distinct GMV alteration was found. These common structural brain abnormalities may underlie the neuropathology of the similar neuropsychological features and highly comorbid manifestations of AN and OCD.

Prior research shows that locked doors and coercive measures are not only applied due to safety concerns, but also due to the specific local tradition of an institution. We examined the association of the use of coercive measures and the admission to a locked ward with person-related characteristics compared to the admission to a specific clinic. In this 15-year, naturalistic observational study, we examined 230,684 admissions to 14 German psychiatric inpatient clinics from Jan 1, 1998, to Dec 31, 2012. To analyze the degree to which admission to a locked ward and coercive measures (received vs. not received) were connected with person- and clinic-specific factors, two-step logistic regression analyses were applied. 27% of the variance of the admission to a locked ward were explained by person-related characteristics (Nagelkerke r² = 0.269). By adding the clinic the person was admitted to, the explained variance increased by 15% (Nagelkerke r² = 0.418). 36% of the variance of the use of coercive measures were explained by person-related characteristics (Nagelkerke r² = 0.364). By adding the clinic the person was admitted to, the explained variance increased by 4% (Nagelkerke r² = 0.400). The local tradition of a psychiatric clinic seems to play a more prominent role for the decision to admit a person to a locked ward than for the decision to use coercive measures. Clinicians should be made aware of the connection of local traditions with clinical pathways in acute psychiatry to avoid unnecessary admissions to locked wards.

Background: Blood-based biomarkers (BBBMs) could significantly facilitate the diagnosis of Alzheimer's disease (AD) and non-AD dementia by providing less invasive alternatives to cerebrospinal fluid (CSF) and positron emission tomography (PET) imaging.

Objective: This study investigated how well the BBBMs-amyloid-β (Aβ) 1-42/1-40 ratio, phosphorylated tau181 (pTau181), apolipoprotein E4 (ApoE4), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL)-reflect thorough clinical work-up validated by PET and CSF biomarkers in participants with AD (n = 27), Aβ-negative CBS (n = 26), and agematched healthy controls (HC) (n = 17).

Methods: Factor and correlation explored biomarker associations. Bayesian regression, backward selection regression, and ROC curve analysis were applied to identify optimal biomarker combinations and diagnostic cut-offs.

Results: In AD cases, pTau181 and ApoE4 levels were elevated, and the Aβ1-42/1-40 ratio was reduced. ROC analysis showed high accuracy for pTau181, ApoE4 and Aβ1-42/1-40 in discriminating AD from HC, with a combination significantly improving performance. However, limited fold change, and high variability reduced the diagnostic applicability of Aβ1-42/1-40 ratio. Elevated NfL levels were the most reliable biomarker for CBS-Aβ(-) cases. GFAP showed limited discriminatory power due to overlapping levels, suggesting that it may not serve as a disease-specific biomarker but may be indicative of general neurodegeneration.

Conclusions: This study highlights the diagnostic utility of pTau181, ApoE4 and the Aβ1-42/1-40 ratio for AD and NfL in the CBS-Aβ(-) cases and emphasizes the added value of combined biomarker models for group differentiation. Prospective studies will help validate these findings and refine clinical thresholds.

Background: Huntington's disease (HD) is a fatal, autosomal dominant neurodegenerative disorder caused by a CAG trinucleotide repeat expansion in the HTT gene. While chorea is the hallmark motor symptom, HD presents with diverse psychiatric and cognitive manifestations that usually precede motor onset.

Methods: A 10-question online survey was distributed to 130 neurologists and neuro-geneticists from the European Huntington's Disease Network (EHDN) to identify clinical symptoms considered pathognonomic of HD and criteria for genetic testing. Responses from 52 specialists were anonymized and analysed using Microsoft Excel and SPSS 26.

Results: Respondents, averaging 18.4 years of experience, universally identified chorea as indicative of HD, alongside cognitive slowing, irritability, and gait abnormalities. Symptoms like neuropathy, limb weakness, and tremor were deemed inconsistent with HD. Notably, 19% of experts reported that ancillary symptoms would not deter them from recommending testing if a primary HD symptom was present. Without a family history, only chorea with or without additional symptoms was deemed sufficient for testing.

Discussion: The findings highlight the complexity of diagnosing HD, the importance of considering subtle psychiatric and cognitive symptoms, and the need for comprehensive patient counselling. Advances in genetic testing and therapeutic trials targeting the molecular root of HD offer hope for curative treatments.

Conclusion: This study underscores the growing recognition of HD's pleiotropy, the ethical considerations in testing, and the importance of clinical vigilance as patients may often first present in a non-neurological setting.

Dysregulation of the endocannabinoid system (ECS) might be related to autism spectrum disorder (ASD). This study conducts a meta-analysis on the dysregulation of the ECS across ASD animal models and individuals with ASD and systematically reviews the impact of these alterations in ASD animal models. Out of 47 papers assessed for eligibility, 16 animal studies and five human studies were included for narrative synthesis and seven and three for quantitative analysis, respectively. The results revealed a significant decrease in hippocampus anandamide (AEA) levels (SMD = -1.06, 95% CI [-1.78, -0.33], p < 0.01) among ASD animal models and a decrease in blood AEA levels in individuals with ASD (SMD = -0.79, 95% CI [-1.28, -0.30], p = 0.002) compared to normal controls. In the prefrontal cortex, 2-arachidonoylglycerol (2-AG) levels were significantly decreased, despite high heterogeneity between studies (SMD = -1.00, 95% CI [-1.93, -0.06], p = 0.04). No significant changes compared to normal controls were observed in levels of AEA (SMD = -0.48, 95% CI [-1.20, 0.25], p = 0.20), 2-AG (SMD = -0.62, 95% CI [-1.27, 0.02], p = 0.06) in combined brain regions. The narrative synthesis revealed that elevated AEA and 2-AG levels could ameliorate core and associated autistic-like symptoms with region and sex-dependent variations in ASD animal models. Future research should focus on specific mechanisms of endocannabinoids regional effects while considering sex-related influences.

The present study aimed to explore the potential neural correlates during feedback evaluation during decision-making under risk and ambiguity in MCI. Nineteen individuals with MCI and twenty age-matched HCs were enrolled. Decision-making performance under risk and ambiguity was examined with the modified game of dice task (GDT) and an Iowa gambling task (IGT). Using task-related EEG data, reward positivity (RewP) and feedback P3 (fb-P3) were used to characterize participants' motivation and allocation of cognitive resources. Also, response time and event-related oscillation (ERO) were used to evaluate information processing speed, and the potent of post-feedback information integration and behavioral modulation. MCI patients had lower RewP (p = 0.022) and fb-P3 (p = 0.045) amplitudes in the GDT than HCs. Moreover, the amount and valence of feedback modulated the RewP (p = 0.008; p = 0.017) and fb-P3 (p < 0.001; p < 0.001). In the IGT, in addition to the significantly reduced fb-P3 observed in MCI patients (p = 0.010), the amount and valence of feedback modulated the RewP (p = 0.002; p = 0.020). Furthermore, MCI patients took longer to make decisions (t = 2.15, p = 0.041). The ERO analysis revealed that delta power was reduced in MCI (GDT: p = 0.045; p = 0.011). The findings suggest that, during feedback evaluation when making risky and ambiguous decisions, motivation, allocation of cognitive resources, information processing and neuronal excitability were attenuated in MCI. It implies that neural activity related to decision making was compromised in MCI.

Introduction: Non-suicidal self-injury (NSSI) is found in over 70% of patients with Borderline Personality Disorder (BPD). The most common method is cutting, which is often used to reduce high levels of aversive tension under stress. Recent studies have shown that pain during injury is a major factor reducing this stress. This report focuses on the question, whether the stress relieving effect of a sharp pain stimulus is different, when the patient herself is inflicting the stimulus on the forearm.

Methods: 86 patients with BPD participated in this study. Stress was induced with a personalized script, followed by a non-invasive pain stimulus with a blunt blade, either self-inflicted or inflicted by the experimenter. Subjective (arousal, urge for NSSI, pain intensity) and objective (heart rate) parameters were measured to evaluate stress and pain. Group differences were analysed using hierarchical linear modelling.

Results: Pain intensity, arousal and the urge for NSSI were similar under both conditions. The initial decrease in heart rate following the pain stimulus was significantly larger when the stimulus was applied by the experimenter and was delayed by a few minutes in the self-inflicted condition.

Conclusions: In this experimental setting, the perspective of pain application (self vs. other) had no differential influence on either NSSI, pain intensity, or stress level. The stronger initial decrease in heart rate in the other-inflicted group during the stimulus may be due to the lack of active physical involvement in the procedure, which could have delayed the decrease of heart rate in the self-inflicted group.

The Aβ42/40 ratio and the concentration of phosphorylated Tau181 in blood plasma represent attractive biomarkers for Alzheimer's disease. As a means for reducing potential matrix effects, which may interfere with plasma immunoassays, we have previously developed a pre-analytical sample workup by semi-automated immunoprecipitation. Here we test the compatibility of pre-analytical immunoprecipitations with automated Aβ1-40, Aβ1-42 and phosphorylated Tau181 immunoassays on the Lumipulse platform and compare the diagnostic performance of the respective immunoprecipitation immunoassay approaches with direct plasma measurements. 71 participants were dichotomized according to their Aβ42/40 ratios in cerebrospinal fluid into the diagnostic groups amyloid-positive (n = 32) and amyloid-negative (n = 39). The plasma Aβ1-42/1-40 ratio and phosphorylated Tau181 levels were determined on the Lumipulse G600II platform (Fujirebio) by direct measurements in EDTA-plasma or after Aβ- or Tau-immunoprecipitation, respectively. Pre-analytical immunoprecipitation of Aβ turned out to be compatible with the Lumipulse Aβ assays and resulted in a numerical, yet statistically not significant increase in the area under the ROC curve for plasma Aβ1-42/1-40. Additionally, we observed a significant increase in the standardised effect size (Cohen's D). Pre-analytical immunoprecipitation of Tau resulted in increased differences between the diagnostic groups in terms of median and mean phosphorylated Tau 181 levels. Furthermore, we observed a greater Cohen's d (p < 0.001) and a larger area under the ROC curve (p = 0.038) after Tau-IP. Our preliminary findings in a small, preselected sample indicate that pre-analytical immunoprecipitation may have the potential to improve the diagnostic performance of plasma biomarker immunoassays for Aβ1-42/1-40 and phosphorylated Tau181 to predict brain amyloid deposition.

Background: Autism spectrum disorder (ASD), a disorder with high heritability, is linked to abnormal cerebral blood flow (CBF) in patients. The present study focuses on exploring the genetic mechanisms behind CBF in ASD.

Methods: A total of 34 children with ASD and 31 typically developing (TD) children were examined to find the inter - group differences in CBF. In combination with the Allen Human Brain Atlas (AHBA), an analysis of transcriptome - neuroimaging spatial association was carried out. This was done to identify genes whose expression was related to CBF changes in ASD, and then gene function characteristics were analyzed.

Results: In comparison with TD children, children with ASD had elevated CBF values in the frontal pole, temporal pole, and thalamus, while having lower CBF values in the superior parietal and caudal middle frontal regions. There were 2,759 genes whose expression was spatially correlated with the CBF changes. Functions such as "Inorganic ion transmembrane transport", "adrenergic signaling in cardiomyocytes", and "neuronal system" were significantly enriched. Significantly down - weighted genes had significant correlations with gamma - aminobutyric acid in the AHBA - seq and DrONc - seq databases.

Conclusion: The transcription - neuroimaging associations arising from cerebral perfusion redistribution in ASD are supplemented in an additional way, which helps in enhancing the understanding of the ASD brain.