European Archives of Psychiatry and Clinical Neuroscience最新文献

As the brain ages, it almost invariably accumulates vascular pathology, which differentially affects the cerebral white matter. A rich body of research has investigated the link between vascular risk factors and the brain. One of the less studied questions is that among various modifiable vascular risk factors, which is the most debilitating one for white matter health? A white matter specific brain age was developed to evaluate the overall white matter health from diffusion weighted imaging, using a three-dimensional convolutional neural network deep learning model in both cross-sectional UK biobank participants (n = 37,327) and a longitudinal subset (n = 1409). White matter brain age gap (WMBAG) was the difference between the white matter age and the chronological age. Participants with one, two, and three or more vascular risk factors, compared to those without any, showed an elevated WMBAG of 0.54, 1.23, and 1.94 years, respectively. Diabetes was most strongly associated with an increased WMBAG (1.39 years, p < 0.001) among all risk factors followed by hypertension (0.87 years, p < 0.001) and smoking (0.69 years, p < 0.001). Baseline WMBAG was associated significantly with processing speed, executive and global cognition. Significant associations of diabetes and hypertension with poor processing speed and executive function were found to be mediated through the WMBAG. White matter specific brain age can be successfully targeted for the examination of the most relevant risk factors and cognition, and for tracking an individual's cerebrovascular ageing process. It also provides clinical basis for the better management of specific risk factors.

The literature suggests that alterations in functional connectivity (FC) of the Salience Network (SN) may contribute to the manifestation of some clinical features of Autism Spectrum Disorder (ASD). The SN plays a key role in integrating external sensory information with internal emotional and bodily information. An atypical FC of this network could explain some symptomatic features of ASD such as difficulties in self-awareness and emotion processing and provide new insights into the neurobiological basis of autism. Using the Autism Brain Imaging Data Exchange II we investigated the resting-state FC of core regions of SN and its association with autism symptomatology in 29 individuals with ASD compared with 29 typically developing (TD) individuals. In ASD compared to TD individuals, seed-based connectivity analysis showed a reduced FC between the rostral prefrontal cortex and left cerebellum and an increased FC between the right supramarginal gyrus and the regions of the middle temporal gyrus and angular gyrus. Finally, we found that the clinical features of ASD are mainly associated with an atypical FC of the anterior insula and the involvement of dysfunctional mechanisms for emotional and social information processing. These findings expand the knowledge about the differences in the FC of SN between ASD and TD, highlighting atypical FC between structures that play key roles in social cognition and complex cognitive processes. Such anomalies could explain difficulties in processing salient stimuli, especially those of a socio-affective nature, with an impact on emotional and behavioral regulation.

Introduction: Intranasal esketamine (ESK) is a novel therapy option in patients with treatment-resistant depression (TRD). Patients with a history of electroconvulsive therapy (ECT) non-response (ECT+) in the current episode have usually been excluded from previous studies. Data on the effectiveness of ESK in ECT non-responders are sparse.

Methods: In this retrospective study, we investigated the effectiveness of intranasal ESK in real-world inpatients with (ECT+, n = 39) history of ECT non-response compared to patients who have not received an adequate course of ECT in their current episode (ECT-, n = 57). A factorial analysis of variance (ANOVA) has been used to determine the impact of ECT non-response on treatment outcome.

Results: A total of n = 96 patients (mean age 47.0; 52.1% women) with TRD were included in this study. There was a significant main effect of history of ECT non-response on MADRS score in the ANOVA (F = 10.386, p = 0.002). However, there was no significant interaction effect of time (pre-treatment, post-treatment)*history of ECT non-response in current episode (F = 2.166, p = 0.143). The response (34.9% vs. 21.9%, χ2 = 1.498, p = 0.167) and remission rates (24.4% vs. 12.1%, χ2 = 1.861, p = 0.141) were none significantly lower in the ECT + group than in the ECT- group. There was significant improvement in MADRS and BDI-II in the ECT + group. No major safety concerns occurred during the study.

Conclusion: There was no significant impact of ECT non-response on esketamine treatment outcome. Our results support the approach to offer esketamine to ECT non-responders given that the array of treatment alternatives is limited for these patients.

Individuals with autism spectrum disorder have deficits in facial emotion recognition and white matter microstructural alterations. Nonetheless, most previous studies were confounded by different variables, such as psychiatric comorbidities and psychotropic medications used by ASD participants. Also, it remains unclear how exactly FER deficits are related to white matter microstructural alterations in ASD. Accordingly, we aimed to investigate the FER functions, white matter microstructure, and their relationship in drug-naive and comorbidity-free ASD individuals. 59 ASD individuals and 59 typically developed individuals were included, where 46 ASD and 50 TD individuals completed FER tasks. Covariance analysis showed scores were lower in both basic and complex FER tasks in the ASD group. Tract-Based Spatial Statistics showed FA values in widespread white matter fibers were lower in the ASD group than in the TD group, including forceps major and forceps minor of the corpus callosum, anterior thalamic radiation, corticospinal tract, cingulum, inferior frontal-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus. Moreover, in the TD group but not the ASD group, the performance in the complex FER task was negatively correlated with the FA value in some white matter fibers, including forceps major of the corpus callosum, ATR, CT, cingulum, IFOF, ILF, SLF. Our study suggests children with ASD may experience deficits in facial emotion recognition and exhibit alterations in white matter microstructure. More importantly, our study indicates that white matter microstructural alterations may be involved in FER deficits in children with ASD.

The composition and characteristics of emergency patients in the Affiliated Brain Hospital, Guangzhou Medical University during 2020-2022 were retrospectively analyzed to provide data support for the optimization of the process of psychiatric emergency and the elastic allocation of emergency medical staff. This study collected data from patients who sought medical attention at the emergency department of the Affiliated Brain Hospital, Guangzhou Medical University between January 1, 2020, and December 31, 2022. The fundamental information of these patients was statistically analyzed using descriptive analytic methods. In addition, a comprehensive statistical analysis was performed on the data of patient visits, which included precise triage time points, months, and seasons, in order to evaluate the temporal distribution of patient visits. The patient population had an average age of 36.4 years and was slightly more female (54.08%). The mean age of the male and female patients was 36.4 ± 18.91 and 36.4 ± 16.80 years, respectively. There was no statistically significant age difference between the male and female patients (p > 0.05). The top five diseases were mental disorder (6,483 cases), bipolar disorder (3,017 cases), depressive episode (2522 cases), schizophrenia (1778 cases) and anxiety state (1097 cases), accounting for 35.63%, 16.58%, 13.86%, 9.77% and 6.03% of the total, respectively. Additionally, a notable record of psychiatric drug intoxication was noted. Significant comorbidity with physical disorders, such as hypertension (9.36%), hypokalemia (3.41%), diabetes (2.83%), and cerebral infarction (2.79%), was also seen. The results of seasonal and monthly analysis indicated that emergency attendance patterns fluctuated, peaking in the spring and fall. The patterns of daily visits also revealed two peak times. The first peak occurs from 8:00 to 10:00, and the second peak occurs from 14:00 to 16:00. This study emphasizes the increasing occurrence of mental problems in psychiatric crises, particularly among younger populations, underscoring the necessity for comprehensive care methods. Specialized treatment methods and collaborative networks are required to address the substantial prevalence of psychiatric medication poisoning. Efficient allocation of resources and heightened security protocols are vital in emergency departments, particularly during periods of high demand and in handling instances of patient hostility.

The PANSS Autism Severity Score (PAUSS) is a popular measure of autistic features in First Episode Psychosis (FEP) samples. However, evidence on its longitudinal stability, course and treatment response is poor. Therefore, the main aim of this research was to compare clinical outcomes between FEP individuals with or without "autistic features" enrolled within an "Early Intervention in Psychosis" (EIP) service across 2 years of follow-up, as well as any significant association with EIP treatment components. FEP subjects completed the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), and the Health of the Nation Outcome Scale (HoNOS) at entry and across the follow-up. Statistical tests included Kaplan-Meyer survival analysis, mixed-design ANOVA, and multiple linear logistic regression analysis. 301 FEP subjects were enrolled (85 [28.0%] scored above the PAUSS cut-off score). Across the follow-up, the PAUSS + subgroup showed lower incidence rates of both symptomatic and functional remission. No PAUSS long-term stability was observed, but a statistically significant reduction in its values. This longitudinal change was mainly predicted by the total number of case management sessions offered within the EIP program. Our results suggest that the PAUSS could not represent a valid instrument to assess "trait-like" autistic features in FEP subjects. On contrary, it seems to capture a FEP subgroup characterized by higher severity levels in psychopathology and poorer outcomes and prognosis.

The β-site amyloid precursor protein-cleaving enzyme 1 (BACE1) gene polymorphism (rs638405) has been widely reported to be associated with Alzheimer's disease (AD) risk. However, studies on the relationship between BACE1 gene polymorphism (rs638405), brain volume, and cognition in AD patients remain scarce. To investigate the effect of genetic polymorphism in BACE1 on gray matter volume (GMV) and cognition in AD, this study recruited 111 cognitively unimpaired (CU) controls and 144 AD patients. The effect of BACE1 rs638405 polymorphism on cognition was explored in CU and AD groups. Then the interaction effect of the diagnosis and BACE1 rs638405 polymorphism on GMV was performed, following the post-hoc analysis of regions of interest (ROIs) in interaction analysis. Mediation analysis was used to elucidate the relationship among genotypes, ROIs and cognition. BACE1 rs638405 G carriers (BACE1 G+) showed significantly lower scores in global cognition and memory function than noncarriers (BACE1 G-) in AD group. Genotypes (G+/G-) and diagnosis (CU/AD) have interaction on GMV of medial temporal lobe (MTL) including the left parahippocampus and right hippocampus. Post-hoc analysis revealed that BACE1 G+ exhibited significantly lower GMV in ROIs compared to BACE1 G- in AD. Finally, mediation analysis further demonstrated that the GMV of ROIs mediated the effect of BACE1 rs638405 polymorphism on cognition in AD. Our results emphasize the BACE1 rs638405 gene polymorphisms may affect the GMV of MTL and cognition in AD, deepening the understanding of AD pathogenesis.

Background: Previous research has indicated a link between social or physical activity and suicide attempt (SA), yet the causal relationship remains unclear, and the role of psychiatric disorders has not been elucidated.

Method: In this study, we used genetic variants of social or physical activity to examine the causal associations with SA based on iPSYCH database, and then replicate the results using FinnGen database.

Results: We found that sports clubs or gyms, walking for pleasure, light DIY and other exercises (e.g. bowling, swimming, cycling, and keep fit) may be protective factors for SA, while leisure/social inactivity may be risk factors. After FDR correction of P value, it was revealed that the OR [95%CI] of SA decreased per SD increase in walking for pleasure (0.23[0.07-0.73]), light DIY (0.21[0.07-0.59]), and other exercise (0.22[0.09-0.58]). Within the replication phase, genetic prediction analyses revealed that walking for pleasure, light DIY, and other exercises were associated with reduced susceptibility to SA (P_FDR < 0.05). Given the high comorbidity between psychiatric disorders and SA, we employed two-step MR and multivariate MR (MVMR) to evaluate the proportions the effect of the mediator. We found that Attention Deficit Hyperactivity Disorder (ADHD) explained 24.48% of the total effect of light DIY on SA, 33.52% of the total effect of other exercises.

Conclusion: Our research findings highlight the protective effect of social/physical activity in SA, and elucidated that increasing light DIY and other exercise can be used as a prevention strategy of SA, particularly for individuals who have ADHD.