European Archives of Psychiatry and Clinical Neuroscience最新文献

This study investigates the decision-making capacities of patients with bipolar disorder (BD) and schizophrenia spectrum disorders (SSD), focusing on differences across four dimensions assessed by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T): Understanding, Appreciation, Reasoning, and Expressing a Choice. A total of 398 patients (237 SSD and 161 BD) were included, with data collected from both inpatient and outpatient settings. Patients with SSD exhibited greater psychopathological severity, were predominantly male, and had a lower level of education compared to BD patients. No significant differences were found between groups in Understanding, Reasoning, or Choice dimensions of the MacCAT-T. However, BD patients scored higher in the Appreciation domain, indicating a better ability to recognize the relevance of medical information to their personal circumstances. Psychopathological severity, measured by the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS), significantly influenced MacCAT-T scores. In SSD patients, conceptual disorganization and lack of judgment negatively impacted decision-making, while BD patients were adversely affected by somatic concerns and hostility. Cognitive impairments, particularly in SSD, appeared to contribute to differences in the Appreciation domain. The study highlights the influence of psychopathology on decisional capacity in severe mental illness, with implications for tailored clinical interventions. Despite similar overall capacity levels between groups, further research is needed to explore the role of cognitive and contextual factors in shaping these abilities. These findings support the use of standardized tools to guide clinical assessments and ensure informed decision-making in psychiatric care.

Background: Problematic alcohol use and mental health problems co-occur frequently. However, the longitudinal, reciprocal relationship between depressive symptoms and problematic alcohol use is not fully understood. This study examined the bidirectional longitudinal association between depressive symptoms and problematic alcohol use.

Methods: A total of 14,569 adults participated in a panel survey, with data collected annually at three time points (2022, 2023, and 2024). Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale (11-item version). Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT) (10-item version). A random intercept cross-lagged panel model (RI-CLPM) with three time points was used to determine the reciprocal relationship between depressive symptoms and problematic alcohol use.

Results: The sample consists of 6,406 men and 8,134 women, with a mean (standard deviation) age of 57.7 (19.5) years. At the between-person level, random intercepts of depressive symptoms and problematic alcohol use showed no significant correlations (B = 0.117, P = .566). At the within-person level, depressive symptoms at a given time point were positively associated with problematic alcohol use in the following year (B = 0.050, P = .005). Similarly, problematic alcohol use at a given time point was positively associated with depressive symptoms in the following year (B = 0.062, P = .012). Significant covariance between depressive symptoms and problematic alcohol use were observed across the survey waves.

Conclusion: This study found a bidirectional longitudinal relationship between depressive symptoms and problematic alcohol use at the within-individual level. Policy interventions should adopt an integrated approach that addresses mental health issues and problematic alcohol use simultaneously.

Background: Individuals with schizophrenia experience premature aging, leading to balance deficits and higher fall risk. Dual-task training integrating balance and cognitive training has emerged as a novel intervention.

Purpose: This study examined the effectiveness of CogBals (i.e., Cognitive and Balance training Simultaneously software), a researcher-developed novel software designed for dual-task training, on balance function, walking performance, lower extremities muscle strength and cognitive function in individuals with schizophrenia.

Method: In a single-blind, parallel-group trial, 84 participants (50.18 ± 7.32 years old; 31 females) were recruited from psychiatric rehabilitation centers in Taiwan and randomly assigned (1:1:1) to a COG&BAL group, balance-only (BAL) group, or treatment as usual control group (TAU). Both training groups received the intervention 2x/week, 60 min/session, 12weeks. The primary outcome was balance functions. Data analysis was conducted using Generalized Estimating Equations.

Result: The mini-BESTest showed improvement in both training groups compared to TAU. The COG&BAL group demonstrated superior improvements in Timed Up and Go Test motor dual-task performance (p=.009), walking speed (p=.010) and stride length (p=.014) under fast walking condition compared to the BAL group. Notably, the TAU group showed significantly decline in balance function. No harms events were identified.

Conclusion: The dual-task training with CogBals enhanced balance and walking performance in middle-aged and older adults with schizophrenia. This intervention shows potential as an effective dual-task balance training approach for fall risk reduction. Future research is suggested to investigate its long-term effects and applicability in various populations.

Background: Antipsychotic therapy in schizophrenia is associated with metabolic and cardiac adverse effects. However, the short-term trajectory of these parameters during controlled inpatient stabilization, and the moderating roles of age and sex, remain less clear.

Methods: This study enrolled 586 inpatients with schizophrenia; all stabilized on an unchanged antipsychotic regimen. Fasting blood glucose (FBG), lipid profiles [triglycerides (TG), Cholesterol (CHOL), high-density lipoprotein (HDL), low density lipoprotein (LDL)], and electrocardiogram (ECG) parameters (heart rate, QRS, PR, QTc) were measured at admission and discharge. Changes were analyzed using paired t-tests and multiple linear regression to assess the influence of age and sex.

Results: From admission to discharge, significant improvements were observed in FBG (mean change: - 0.56 ± 0.07 mmol/L, pFDR < 0.01) and heart rate (mean change: - 3.81 ± 0.92 bpm, pFDR < 0.01). A significant reduction in HDL was also found (mean change: - 0.11 ± 0.02 mmol/L, pFDR < 0.01). Age-stratified analysis revealed a significant QTc shortening exclusively in patients > 45 years old (p < 0.05). Regression analysis identified sex as a significant independent predictor of HDL change (β = 0.068, p = 0.016).

Conclusion: The inpatient stabilization phase is a dynamic period marked by both beneficial (improved glycemia, lower heart rate) and adverse (reduced HDL) physiological changes. The differential effects based on age (QTc shortening) and sex (HDL change) underscore the necessity for personalized cardiometabolic monitoring and risk mitigation strategies in patients with schizophrenia.