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Mental health provision for children affected by war and armed conflicts. 为受战争和武装冲突影响的儿童提供心理健康服务。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 Epub Date: 2024-06-15 DOI: 10.1007/s00787-024-02492-w
Panos Vostanis
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引用次数: 0
A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. 关于欧洲儿童和青少年精神障碍患病率的系统回顾和荟萃分析。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 Epub Date: 2022-12-30 DOI: 10.1007/s00787-022-02131-2
Rosemarie Sacco, Nigel Camilleri, Judith Eberhardt, Katja Umla-Runge, Dorothy Newbury-Birch

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

大多数精神障碍在 14 岁之前就已出现,但在大多数情况下,直到成年后仍未得到诊断和治疗。一项范围界定审查显示,目前缺乏针对欧洲儿童和青少年精神障碍患病率的系统性审查,这些审查基于 2015 年至 2020 年间开展的社区研究。为了估算焦虑症、抑郁症、注意力缺陷多动障碍 (ADHD)、行为障碍 (CD)、对立违抗障碍 (ODD)、自闭症谱系障碍、进食障碍、药物使用障碍 (SUD) 在欧洲儿童和青少年中的最新汇总患病率,我们使用 MEDLINE、Embase 和 Psych Info 进行了检索,并从参考文献列表和灰色文献中找到了相关研究。对符合条件的研究进行了可靠性、有效性和偏差评估。对每种精神障碍的患病率趋势进行了计算。在欧洲,几乎每五个年轻人中就有一人患有精神障碍,综合患病率为 15.5%。焦虑症的综合患病率最高(7.9% (95% CI 5.1-11.8%, I2: 98.0%)),其次是多动症(2.9% (95% CI 1.2-6.9%, I2 = 94.3%))、定向障碍(1.9% (95% CI 1.0-3.7%,I2 = 98.4%)、抑郁障碍(1.7%(95% CI 1.0-2.9%,I2 = 97.7%))、CD(1.5%(95% CI 0.6-3.8%,I2 = 98.8%))和 ASD(1.4%(95% CI 0.4-5.4%,I2 = 99.7%)。没有发现有关 SUD 的研究。通过引入常规筛查、提高诊断敏感性、提高对精神障碍的认识、尽量减少污名化和社会经济不平等,以及发展早期干预服务,可以改善儿童和青少年的心理健康。需要优先考虑这些促进良好心理健康的因素,尤其是在心理健康不良的风险因素前所未有的时候。
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引用次数: 0
Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months? 小学学龄儿童的邻里贫困是否与他们的心理健康有关,这种关联在 30 个月内是否会发生变化?
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 Epub Date: 2024-02-14 DOI: 10.1007/s00787-024-02385-y
Katie Finning, Amy Haeffner, Sohum Patel, Bryony Longdon, Rachel Hayes, Obioha C Ukoumunne, Tamsin Ford

As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4-9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97-3.89) and 18 months (1.96, 1.07-3.59) but not 30 months (0.94, 0.54-1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation.

由于社会经济贫困和儿童心理健康问题的发生率都在持续上升,探索两者之间的关系对于指导政策的制定非常重要。我们的目标是复制一项发现,即生活在最贫困地区和最不贫困地区的小学生之间的心理健康差距随着年龄的增长而扩大。我们使用了英格兰西南部 2075 名 4-9 岁儿童的数据,这些儿童参加了 STARS(学校支持教师和儿童)试验,该试验在基线、18 个月和 30 个月的随访中收集了教师和家长报告的 "优势和困难问卷"(SDQ)。我们建立了多层次回归模型,以探讨多重贫困指数(IMD)五分位数与 SDQ 总困难得分之间的关系,以及结合教师和家长的 SDQ 数据通过算法生成的 "可能失调 "变量之间的关系。教师和家长报告的 SDQ 总困难得分表明,生活在较贫困社区的儿童心理健康状况较差,在控制了特殊教育需求和残疾后,这种情况有所减弱,但家长报告的得分仍然显著,而且基线年级组状况(年龄)不存在交互作用。尽管与时间的交互作用很明显(p = 0.003),但我们并未发现可能的失调与 IMD 之间存在关联。按研究波次进行的分析表明,基线(几率比 1.94,95% 置信区间 0.97-3.89)和 18 个月(1.96,1.07-3.59)时存在关联,但 30 个月(0.94,0.54-1.57)时不存在关联。这些发现增强了现有的、极具说服力的证据,这些证据表明,社会经济贫困儿童的心理健康状况更差。
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引用次数: 0
Do maternal anxiety and depressive symptoms predict anxiety in children with and without ADHD at 8 years? 母亲的焦虑和抑郁症状能否预测患有和未患有多动症的 8 岁儿童的焦虑情况?
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 Epub Date: 2024-02-20 DOI: 10.1007/s00787-024-02374-1
Christine Baalsrud Ingeborgrud, Beate Oerbeck, Svein Friis, Are Hugo Pripp, Pål Zeiner, Heidi Aase, Guido Biele, Søren Dalsgaard, Kristin Romvig Overgaard

Maternal anxiety and depression during pregnancy and early childhood have been associated with child anxiety and attention-deficit/hyperactivity disorder (ADHD). However, previous studies are limited by their short follow-up, few assessments of maternal symptoms, and by not including maternal and child ADHD. The present study aimed to fill these gaps by investigating whether maternal anxiety and depressive symptoms from pregnancy to child age 5 years increase the risk of child anxiety disorders at age 8 years. This study is part of the population-based Norwegian Mother, Father, and Child Cohort Study. Maternal anxiety and depressive symptoms were assessed by the Hopkins Symptom Checklist (SCL) six times from pregnancy through early childhood, and ADHD symptoms by the Adult Self-Report Scale (ASRS). At age 8 years (n = 781), symptoms of anxiety disorders and ADHD were assessed, and disorders classified by the Child Symptom Inventory-4. Logistic regression models estimated the risk of child anxiety depending on maternal symptoms. The mothers of children classified with an anxiety disorder (n = 91) scored significantly higher on the SCL (at all time points) and ASRS compared with the other mothers. In univariable analyses, maternal anxiety and/or depression and ADHD were associated with increased risk of child anxiety (odds ratios = 2.99 and 3.64, respectively), remaining significant in the multivariable analysis adjusted for covariates. Our findings link maternal anxiety, depression, and ADHD during pregnancy and early childhood to child anxiety at age 8 years.

孕期和幼儿期的母亲焦虑和抑郁与儿童焦虑和注意力缺陷/多动症(ADHD)有关。然而,以往的研究由于随访时间短、对母亲症状的评估较少以及未将母亲和儿童多动症包括在内而受到限制。本研究旨在填补这些空白,调查母亲从怀孕到孩子 5 岁期间的焦虑和抑郁症状是否会增加孩子 8 岁时患焦虑症的风险。这项研究是以人口为基础的挪威母亲、父亲和儿童队列研究的一部分。母亲的焦虑和抑郁症状由霍普金斯症状检查表(SCL)进行评估,从怀孕到幼儿期共进行了六次,多动症状由成人自我报告量表(ASRS)进行评估。对 8 岁儿童(n = 781)的焦虑症和多动症症状进行评估,并通过儿童症状量表-4 对症状进行分类。逻辑回归模型根据母亲的症状估算出儿童患焦虑症的风险。与其他母亲相比,焦虑症患儿的母亲(n = 91)在 SCL(所有时间点)和 ASRS 中的得分明显较高。在单变量分析中,母亲焦虑和/或抑郁以及多动症与儿童焦虑风险的增加有关(几率比分别为 2.99 和 3.64),在调整协变量后的多变量分析中仍然显著。我们的研究结果将孕期和幼儿期的母亲焦虑、抑郁和多动症与儿童 8 岁时的焦虑联系起来。
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引用次数: 0
Randomized controlled trial of individualized arousal-biofeedback for children and adolescents with disruptive behavior disorders (DBD). 针对患有破坏性行为障碍(DBD)的儿童和青少年的个性化唤醒生物反馈随机对试验。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 Epub Date: 2024-02-08 DOI: 10.1007/s00787-023-02368-5
Pascal-M Aggensteiner, Boris Böttinger, Sarah Baumeister, Sarah Hohmann, Stefan Heintz, Anna Kaiser, Alexander Häge, Julia Werhahn, Christoph Hofstetter, Susanne Walitza, Barbara Franke, Jan Buitelaar, Tobias Banaschewski, Daniel Brandeis, Nathalie E Holz

Disruptive behavior disorders [including conduct disorder (CD) and oppositional defiant disorder (ODD)] are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. A total of 37 children aged 8-14 years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive-behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits, and the Reactive-Proactive Aggression Questionnaire. The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted.

破坏性行为障碍(包括品行障碍(CD)和对立违抗障碍(ODD))是常见的儿童和青少年精神疾病,通常与唤醒改变有关。推荐的一线治疗方法是多模式疗法,包括社会心理和行为干预。这些治疗方法的效果并不显著,而且在临床和生物学上存在异质性表型,因此需要针对唤醒失调等受损功能进行创新的个性化治疗。共有 37 名 8-14 岁被诊断为 ODD/CD 的儿童被随机分配到 20 个疗程的个性化唤醒生物反馈治疗(使用皮肤电导水平 (SCL-BF))或积极的常规治疗(TAU)(包括心理教育和认知行为元素)中。主要结果是父母对攻击行为的评分变化,采用改良的外显攻击量表进行测量。次要结果测量是儿童行为检查表、冷酷无情-情绪特质量表和反应-主动攻击问卷的子量表。SCL-BF疗法既不优于也不劣于积极的TAU疗法。治疗后,两组的攻击行为都有所减少,对主要结果的影响较小,而对一些次要结果的影响较大。重要的是,在治疗后的评估中,成功学习 SCL 自我调节与攻击行为的减少有关。在改善攻击行为的任何治疗结果上,个体化的 SCL-BF 都不逊色于积极的 TAU。此外,参与者平均能够自我调节他们的SCL,而那些最善于学习自我调节的人表现出了最高的临床改善,这表明SCL-BF调节在改善攻击性方面具有特异性。我们有必要利用更多的样本和改进的方法开展进一步的研究,例如在生态学上更有效的环境中开发移动使用的 BF。
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引用次数: 0
Integrating European contexts and needs into WHO guiding principles on online mental health content for young people: five recommendations. 将欧洲背景和需求纳入世卫组织关于青少年在线心理健康内容的指导原则:五项建议。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-08-29 DOI: 10.1007/s00787-024-02566-9
Helena Ludwig-Walz, Martin Bujard, Jonas Fegert, Jörg M Fegert
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引用次数: 0
Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review. 父母患有重度情感障碍的后代的下丘脑-垂体-肾上腺轴功能:荟萃分析综述。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-08-29 DOI: 10.1007/s00787-024-02553-0
Lisa Serravalle, Florencia Trespalacios, Mark A Ellenbogen

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

由于患有情感障碍(OAD)的父母的后代患精神疾病的风险很高,而情感障碍(AD)患者表现出下丘脑-垂体-肾上腺(HPA)轴活动失调,因此,OAD 患者 HPA 功能的变化可能是 ADs 发病前的一个致病风险因素。荟萃分析的主要目的是定量总结有关 OAD 中不同昼皮质醇指数的现有数据。次要目的是探索这种关系的潜在调节因素。按照 PRISMA 指南,我们在初步筛选了 3408 篇文章后,将 26 项有关昼皮质醇的研究(3052 名后代)纳入了荟萃分析。我们使用稳健方差估计法计算了纯截距模型和元回归模型。对离散时间点的平均皮质醇水平、皮质醇总输出量和皮质醇对觉醒反应的上升(CAR)分别进行了分析。结果表明,与对照组相比,OAD 在全天不同时间点的皮质醇平均水平更高(Hedge's g = 0.21)。有证据表明,在研究 CAR 的研究中存在发表偏倚,因此效应大小存在正偏倚。本研究结果与一项荟萃分析结果一致,后者显示患有注意力缺失症的青少年皮质醇升高。各项研究的显著局限性包括皮质醇测量方法和注意力缺失评估。总之,这些结果突出表明,皮质醇水平升高可能是高危青少年罹患注意力缺失症的潜在神经内分泌先兆和/或风险因素。
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引用次数: 0
The developmental course of adolescent paranoia: a longitudinal analysis of the interacting role of mistrust and general psychopathology. 青少年妄想症的发展过程:对不信任和一般精神病理学相互作用的纵向分析。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-08-29 DOI: 10.1007/s00787-024-02563-y
Gennaro Catone, Vincenzo Paolo Senese, Antonio Pascotto, Simone Pisano, Matthew R Broome

Paranoia is the erroneous idea that people are targeting you for harm, and the cognitive model suggests that symptoms increase with emotional and relational distress. A factor potentially associated with paranoia is mistrust, a milder form of suspiciousness. This study investigated the longitudinal course of non-clinical paranoia in a sample of 739 students (age range 10-12 at baseline assessment, 12-14 at second assessment) using data from the Social Mistrust Scale (SMS) and the paranoia subscale of the Specific Psychotic Experiences Questionnaire (SPEQ). Prevalence of mistrustful and high paranoia children was 14.6 and 15% respectively. Independently, baseline internalizing symptoms (b = 0.241, p < 0.001) and mistrust (b = 0.240, p < 0.001) longitudinally predict paranoia after controlling for confounders. The interaction of mistrust and internalizing symptoms at T1 increases the possibility of the onset of paranoia at T2. Therefore, the effect of mistrust on paranoia is more marked when internalizing symptoms are higher. Our results confirm the role of mistrust as a factor involved in the developmental trajectory of paranoia in adolescence, enhanced by the presence of internalizing symptoms. The implications of these results are both theoretical and clinical, as they add developmental information to the cognitive model of paranoia and suggests the assessment and clinical management of mistrust and internalizing symptoms in youth may be useful with the aim of reducing the risk of psychotic experiences.

妄想症是一种错误的想法,认为别人正在以你为伤害目标,认知模式表明,症状会随着情绪和关系困扰的增加而加重。与妄想症潜在相关的一个因素是不信任,这是一种较温和的多疑形式。本研究使用社会不信任量表(SMS)和特殊精神病经历问卷(SPEQ)中的妄想症分量表的数据,调查了 739 名学生(基线评估时年龄在 10-12 岁之间,第二次评估时年龄在 12-14 岁之间)非临床妄想症的纵向发展过程。不信任和高度偏执儿童的患病率分别为 14.6%和 15%。另外,基线内化症状(b = 0.241,p
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引用次数: 0
Reply: the inclusion of methylphenidate in the WHO list of essential medicines is endorsed by millions of people with ADHD. 答复:将哌醋甲酯列入世卫组织基本药物清单得到了数百万多动症患者的认可。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-08-28 DOI: 10.1007/s00787-024-02570-z
Samuele Cortese, David Coghill, Joerg M Fegert, Gregory W Mattingly, Luis A Rohde, Ian C K Wong, Stephen V Faraone
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引用次数: 0
Risk factor patterns define social anxiety subtypes in adolescents with brain and clinical feature differences. 青少年社交焦虑亚型的风险因素模式与大脑和临床特征的差异。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-08-28 DOI: 10.1007/s00787-024-02548-x
Yinzhi Kang, Qingfeng Li, Wenjing Liu, Yang Hu, Zhen Liu, Shuqi Xie, Changminghao Ma, Lei Zhang, Xiaochen Zhang, Zhishan Hu, Yue Ding, Wenhong Cheng, Zhi Yang

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

社交焦虑症(SAD)是青少年最常见的精神疾病之一。症状和病因的异质性是导致 SAD 治疗和预防困难的重要原因。本研究旨在根据病因相关的表型维度确定青少年 SAD 的亚型,并研究亚型的症状和大脑关联。我们对患有 SAD 的青少年(196 人)和健康对照组(109 人)进行了深度表型抽样(13 项测量中的 47 个表型子量表),提取了与病因相关的风险因素,并在此基础上确定了 SAD 的亚型。我们比较了这些亚型的临床特征、大脑形态计量学和功能连接,并研究了风险因素、大脑畸变和临床特征之间的亚型特异性联系。我们发现了六种与病因相关的风险因素和两种青少年 SAD 亚型。其中一种亚型主要表现为消极情绪特质和应对方式的升高,以及积极情绪特质和应对方式的降低,而另一种亚型则具有明显的高环境风险因素、更严重的社会功能障碍以及大脑结构和功能的显著异常。风险因素特征、大脑异常和临床特征之间存在亚型特异性联系。研究结果表明,青少年 SAD 有两种基于病因的亚型,为病理途径的多样性和精确干预策略提供了新的见解。
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European Child & Adolescent Psychiatry
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