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Original article: adolescent dietary patterns derived using principal component analysis and neuropsychological functions: a cross-sectional analysis of Walnuts Smart Snack cohort 原文:利用主成分分析和神经心理功能得出的青少年饮食模式:对核桃智能零食队列的横断面分析
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-18 DOI: 10.1007/s00787-024-02577-6
Nicolas Ayala-Aldana, Ariadna Pinar-Martí, Marina Ruiz-Rivera, Sílvia Fernández-Barrés, Dora Romaguera, Jordi Casanova-Mollà, Nuria Solà-Valls, Jordi Julvez

A balanced diet is relevant for neuropsychological functioning. We aimed to analyze the association between dietary patterns and neuropsychological outcomes in a sample of healthy adolescents of the Walnuts Smart Snack (WSS) cohort from Barcelona city. We performed principal components analysis (PCA) to determine dietary patterns in the adolescent sample using a food frequency questionnaire (60 items). Multiple linear regression models were performed to analyze the association between PCA dietary patterns with neuropsychological outcomes: Strengths and Difficulties (SDQ) externalizing and internalizing scores, Attention Network Test (ANT) Impulsivity Index and Emotional Recognition Task (ERT) scores. We additionally adjusted the models for child sex, age, body mass index (BMI), physical activity and maternal education. Six dietary patterns were identified in PCA analyses. “low consumption of calorie-dense foods” dietary pattern had a negative association (protective) with the both SDQ outcomes (p value < 0.001) and “Nuts” dietary pattern showed a negative (protective) association with impulsivity index (:{(beta:}_{1})= −24.60, 95% CI = −36.80, −12.41, p value < 0.001). Overall, our main results suggest that healthy dietary patterns, including higher intakes of “nuts” and a preference of “low consumption of calorie-dense foods” dietary patterns, could provide a beneficial association with neuropsychological functions during the adolescence period. The associations may include improvements of externalizing and internalizing problem symptoms, and impulsivity.

均衡饮食与神经心理功能有关。我们的目的是分析巴塞罗那市核桃智能零食(WSS)队列中健康青少年样本的饮食模式与神经心理学结果之间的关联。我们采用主成分分析法(PCA),通过食物频率问卷(60 个项目)确定青少年样本的饮食模式。我们采用多元线性回归模型来分析 PCA 饮食模式与神经心理学结果之间的关联:优势与困难(SDQ)外化和内化得分、注意力网络测试(ANT)冲动指数和情绪识别任务(ERT)得分。此外,我们还根据儿童的性别、年龄、体重指数(BMI)、体力活动和母亲教育程度对模型进行了调整。在 PCA 分析中确定了六种饮食模式。"低热量高密度食物摄入量 "饮食模式与SDQ结果均呈负相关(保护性)(p值为0.001),"坚果 "饮食模式与冲动指数呈负相关(保护性)(:{(beta:}_{1})= -24.60, 95% CI = -36.80, -12.41, p值为0.001)。总之,我们的主要研究结果表明,健康的膳食模式,包括摄入更多的 "坚果 "和偏好 "低热量高密度食物 "的膳食模式,会对青少年时期的神经心理功能产生有益的影响。这种关联可能包括改善外化和内化问题症状以及冲动性。
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引用次数: 0
The correlation of inflammation, tryptophan-kynurenine pathway, and suicide risk in adolescent depression 炎症、色氨酸-犬尿氨酸通路与青少年抑郁症自杀风险的相关性
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-17 DOI: 10.1007/s00787-024-02579-4
Shuran Yang, Jingjing Han, Zhihan Ye, Huizhi Zhou, Yangye Yan, Dong Han, Shi Chen, Lu Wang, Qiang Feng, Xudong Zhao, Chuanyuan Kang

Accumulating evidence suggests a role for the tryptophan-kynurenine pathway (TKP) in the psychopathology of major depressive disorder (MDD). Abnormal inflammatory profile and production of TKP neurotoxic metabolites appear more pronounced in MDD with suicidality. Progress in understanding the neurobiology of MDD in adolescents lags significantly behind that in adults due to limited empirical evidence. Aims of this study was to investigate the association between inflammation, TKP, and suicidality in adolescent depression. Seventy-three adolescents with MDD were assessed for serum levels of interleukin (IL)-1β, IL-6, IL-18, IL-10, tumor necrosis factor-α (TNF-α), tryptophan (TRP), kynurenine (KYN), 3-hydroxykynurenine (3-HK), and kynurenine acid (KA). Correlations between cytokines and TKP measures were examined. Patients were divided into high- (n = 42) and non-high-suicide-risk groups (n = 31), and serum levels of cytokines and TKP metabolites were compared. Significant negative correlations were found between TRP and IL-8 (r = – 0.27, P < 0.05) and IL-10 (r = – 0.23, P < 0.05), while a significant positive correlation was observed between 3-HK and IL-8 (r = 0.39, P < 0.01) in depressed adolescents. The KYN/TPR (index of indoleamine 2,3-dioxygenase, IDO) was positively correlated with IL-1β (r = 0.34), IL-6 (r = 0.32), IL-10 (r = 0.38) and TNF-α (r = 0.35) levels (P < 0.01); and 3-HK/KYN (index of kynurenine3-monooxidase, KMO) was positively correlated with IL-8 level (r = 0.31, P < 0.01). Depressed adolescents at high suicide risk exhibited significantly higher levels of IL-1β (Z = 2.726, P < 0.05), IL-10 (Z = 2.444, P < 0.05), and TNF-α (Z = 2.167, P < 0.05) and lower levels of 3-HK (Z = 2.126, P < 0.05) compared to their non-high suicide risk counterparts. Our findings indicated that serum inflammatory cytokines were robustly associated with IDO and KMO activity, along with significantly decreased serum level of TRP, increased level of 3-HK, and higher suicide risk in adolescent depression.

越来越多的证据表明,色氨酸-犬尿氨酸通路(TKP)在重度抑郁障碍(MDD)的精神病理学中发挥作用。在伴有自杀倾向的重度抑郁症患者中,异常炎症特征和 TKP 神经毒性代谢产物的产生似乎更为明显。由于经验证据有限,对青少年重度抑郁症神经生物学的研究进展明显落后于成人。本研究旨在调查青少年抑郁症患者的炎症、TKP 和自杀倾向之间的关系。研究人员对73名患有抑郁症的青少年进行了血清白细胞介素(IL)-1β、IL-6、IL-18、IL-10、肿瘤坏死因子-α(TNF-α)、色氨酸(TRP)、犬尿氨酸(KYN)、3-羟基犬尿氨酸(3-HK)和犬尿氨酸(KA)水平的评估。研究了细胞因子与 TKP 测量值之间的相关性。患者被分为高自杀风险组(42 人)和非高自杀风险组(31 人),并比较了血清中细胞因子和 TKP 代谢物的水平。研究发现,在抑郁青少年中,TRP 与 IL-8 (r = - 0.27,P < 0.05)和 IL-10 (r = - 0.23,P < 0.05)呈显著负相关,而 3-HK 与 IL-8 (r = 0.39,P < 0.01)呈显著正相关。KYN/TPR(吲哚胺-2,3-二氧化酶指数,IDO)与IL-1β(r = 0.34)、IL-6(r = 0.32)、IL-10(r = 0.38)和TNF-α(r = 0.35)水平呈正相关(P <0.01);3-HK/KYN(犬尿氨酸-3-单氧化酶指数,KMO)与IL-8水平呈正相关(r = 0.31,P <0.01)。与非高自杀风险青少年相比,高自杀风险抑郁青少年的 IL-1β (Z = 2.726, P < 0.05)、IL-10 (Z = 2.444, P < 0.05)和 TNF-α (Z = 2.167, P < 0.05)水平明显较高,而 3-HK (Z = 2.126, P < 0.05)水平较低。我们的研究结果表明,在青少年抑郁症患者中,血清炎症细胞因子与IDO和KMO活性密切相关,血清TRP水平显著降低,3-HK水平显著升高,自杀风险较高。
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引用次数: 0
Callous-unemotional traits moderate the association between inhibitory control and disruptive behavior problems 冷酷无情的情绪特质缓和了抑制控制与破坏性行为问题之间的关系
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-14 DOI: 10.1007/s00787-024-02582-9
Peter J. Castagna, Dara E. Babinski, Daniel A. Waschbusch

The presence of callous-unemotional (CU) traits may not be unique to conduct disorder (CD) but also extend to oppositional defiant disorder (ODD). While a distinct neurocognitive profile characterizes CU traits, it remains unclear whether this CU-related neurocognitive profile differs between youth with CD and ODD. This study investigated whether CU traits moderate the relationship between inhibitory control and CD or ODD symptoms. We leveraged computational modeling to decompose task-based inhibitory control in a sample of 200 children (59.5% boys, 86.5% Caucasian), aged 8 to 15 years (M = 10.10, SD = 1.88), referred to an outpatient child diagnostic clinic focused on externalizing problems. Analyses examined whether CU traits moderated the relationship between inhibitory control and CD or ODD symptoms while controlling for ADHD symptoms and child demographics. The results indicated that the strength of the relationship between inhibitory control and CD and ODD symptoms varies as a function of CU traits. Specifically, CD was linked to a more cautious decision-making style when elevated CU traits were present, whereas ODD was associated with more efficient decision making. These findings suggest distinct neurocognitive profiles based on CU traits, which vary between CD and ODD. Clinically, this underscores the importance of tailoring interventions for CD-CU and ODD-CU, focusing on decision making processes rather than merely addressing impulsivity. This research contributes to a more nuanced understanding of the interaction between neurocognitive processes and disruptive behavior, with significant implications for both theoretical models and treatment approaches.

冷酷无情(CU)特质的存在可能并不是行为障碍(CD)所独有的,它也可能延伸至对立违抗障碍(ODD)。虽然CU特质具有独特的神经认知特征,但这种与CU相关的神经认知特征在CD和ODD青少年之间是否存在差异仍不清楚。本研究调查了CU特质是否会缓和抑制控制与CD或ODD症状之间的关系。我们利用计算模型分解了200名儿童(59.5%为男孩,86.5%为白种人)的任务型抑制控制,这些儿童的年龄在8至15岁之间(中=10.10,标差=1.88),他们被转介到一家专注于外化问题的儿童诊断门诊。在控制多动症症状和儿童人口统计学特征的情况下,研究分析了 CU 特征是否调节了抑制控制与 CD 或 ODD 症状之间的关系。结果表明,抑制控制与 CD 和 ODD 症状之间的关系强度随 CU 特质的变化而变化。具体地说,当CU特质升高时,CD与更谨慎的决策风格有关,而ODD则与更高效的决策有关。这些研究结果表明,基于CU特质的不同神经认知特征在CD和ODD之间存在差异。在临床上,这强调了针对 CD-CU 和 ODD-CU 定制干预措施的重要性,干预措施应侧重于决策过程,而不仅仅是解决冲动问题。这项研究有助于人们更细致地了解神经认知过程与破坏性行为之间的相互作用,对理论模型和治疗方法都具有重要意义。
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引用次数: 0
Should methylphenidate be included in the WHO model lists of essential medicines? 哌醋甲酯是否应列入世卫组织基本药物示范清单?
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-12 DOI: 10.1007/s00787-024-02565-w
Johanne Pereira Ribeiro,Christian Gluud,Maja Rosenberg Overby Storm,Ole Jakob Storebø
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引用次数: 0
Mentalization-based interventions in schools for enhancing socio-emotional competencies and positive behaviour: a systematic review 在学校采取以心理化为基础的干预措施,提高社会情感能力和积极行为:系统性综述
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-12 DOI: 10.1007/s00787-024-02578-5
Gali Chelouche-Dwek, Peter Fonagy

Mentalization-based interventions (MBIs) have been increasingly applied in school settings to support the social-emotional development and mental health of children and adolescents. This systematic review aimed to synthesize the evidence on the effectiveness of MBIs implemented in educational contexts for students aged 6–18 years. A comprehensive search was conducted in PsychInfo, MEDLINE, EMBASE, Web of Science, and ERIC databases from inception to October 2023. The search strategy combined terms related to mentalization, school-based interventions, and the target age group. The review protocol was registered with PROSPERO (CRD42022302757). Inclusion criteria included peer-reviewed publications in English, studies published between 1980 and 2023, interventions based on mentalization principles, and a primary focus on children aged 6 to 18 years. Exclusion criteria involved non-mentalization based interventions and research outside the 6–18 age range. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health (NIH). Data were synthesized narratively due to the heterogeneity of study designs and outcomes. Of the 5,250 articles screened, 21 studies met the inclusion criteria, comprising over 7,500 participants. The reviewed interventions targeted various aspects of mentalizing, such as emotion-understanding, empathy, perspective-taking, and Theory of Mind. Significant improvements were found in social-cognitive abilities, emotion regulation, and mental health outcomes, including reductions in disruptive behaviours. Interventions that combined mentalizing training for both students and teachers showed promising results. However, the long-term sustainability of these benefits remains unclear. Limitations of the reviewed studies include the lack of control groups, small sample sizes, and variations in outcome measures. The findings highlight the potential of MBIs as a promising approach to fostering socio-emotional competence, positive behaviour, and well-being in school-aged children. Future research should aim to establish the active components and optimal delivery of these interventions through well-designed randomized controlled trials with larger, more diverse samples and extended follow-up periods. The integration of MBIs within educational systems holds promise for promoting resilience and positive mental health outcomes in young people. Embedding MBIs within school curriculums and evaluating cost-effectiveness are important next steps to guide widespread implementation.

以心理化为基础的干预措施(MBIs)越来越多地被应用于学校环境中,以支持儿童和青少年的社会情感发展和心理健康。本系统性综述旨在总结在教育环境中对 6-18 岁学生实施心理干预的有效性证据。从开始到 2023 年 10 月,我们在 PsychInfo、MEDLINE、EMBASE、Web of Science 和 ERIC 数据库中进行了全面检索。检索策略结合了与心理化、校本干预和目标年龄组相关的术语。综述方案已在 PROSPERO 注册(CRD42022302757)。纳入标准包括经同行评审的英文出版物、1980 年至 2023 年间发表的研究、基于心智化原则的干预措施以及主要针对 6 至 18 岁儿童的研究。排除标准包括非心理化干预措施和 6-18 岁年龄段以外的研究。使用美国国立卫生研究院(NIH)的质量评估工具对偏倚风险进行了评估。由于研究设计和结果的异质性,我们对数据进行了叙述性综合。在筛选出的 5250 篇文章中,有 21 项研究符合纳入标准,参与者超过 7500 人。所审查的干预措施针对心智化的各个方面,如情绪理解、移情、透视和心智理论。结果发现,干预措施在社会认知能力、情绪调节和心理健康方面都有显著改善,包括减少了破坏性行为。针对学生和教师的心理训练相结合的干预措施显示出良好的效果。然而,这些益处的长期可持续性仍不明确。所回顾研究的局限性包括缺乏对照组、样本量小以及结果测量的差异。这些研究结果突出表明,作为培养学龄儿童社会情感能力、积极行为和幸福感的一种有前途的方法,积极主动学习法具有很大的潜力。未来的研究应着眼于通过精心设计的随机对照试验,以更大规模、更多样化的样本和更长的随访期来确定这些干预措施的积极成分和最佳实施方式。将心理健康干预纳入教育体系,有望提高青少年的抗挫折能力和积极的心理健康成果。将 MBI 纳入学校课程和评估成本效益是指导广泛实施的重要步骤。
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引用次数: 0
Social isolation and poor mental health in young people: testing genetic and environmental influences in a longitudinal cohort study 年轻人的社会隔离和不良心理健康:在一项纵向队列研究中检验遗传和环境影响因素
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-11 DOI: 10.1007/s00787-024-02573-w
Katherine N. Thompson, Olakunle Oginni, Jasmin Wertz, Andrea Danese, Malaika Okundi, Louise Arseneault, Timothy Matthews

We assessed genetic and environmental influences on social isolation across childhood and the overlap between social isolation and mental health symptoms including depression symptoms, conduct problems, and psychotic-like experiences from adolescence to young adulthood. Participants included 2,232 children from the Environmental Risk Longitudinal Twin Study. Social isolation was measured at ages 5, 7, 10, 12, and 18. A Cholesky decomposition was specified to estimate the genetic and environmental influences on social isolation across ages 5, 7, 10, and 12. An independent pathway model was used to assess additive genetic (A), shared environmental (C), and non-shared environmental (E) influences on the overlap between social isolation and mental health problems from age 12 to 18. Genetic and non-shared environmental influences accounted for half of the variance in childhood social isolation. Genetic influences contributed to the continuity of social isolation across childhood, while non-shared environmental influences were age-specific. The longitudinal overlap between social isolation and mental health symptoms was largely explained by genetic influences for depression symptoms (r = 0.15–0.24: 82–84% A, 11–12% C, and 5–6% E) and psychotic-like experiences (r = 0.13–0.15: 81–91% A, 0–8% C, and 9–11% E) but not conduct problems (r = 0.13–0.16; 0–42% A, 42–81% C, 16–24% E). Our findings emphasise that rather than a risk factor or an outcome, social isolation is aetiologically intertwined with the experience of poor mental health. An integrative assessment of social isolation could be a helpful indicator of underlying mental health symptoms in young people.

我们评估了遗传和环境对儿童期社会隔离的影响,以及社会隔离与心理健康症状(包括抑郁症状、品行问题和青春期至青年期的精神病样经历)之间的重叠。研究对象包括环境风险纵向双胞胎研究中的 2,232 名儿童。社会隔离度在 5、7、10、12 和 18 岁时进行测量。采用 Cholesky 分解法估算了 5、7、10 和 12 岁时遗传和环境对社会隔离的影响。独立路径模型用于评估遗传(A)、共享环境(C)和非共享环境(E)对 12 至 18 岁期间社会隔离与心理健康问题重叠的影响。遗传和非共享环境影响占童年社会隔离差异的一半。遗传因素使儿童时期的社会隔离具有连续性,而非共同环境因素则具有年龄特异性。社会隔离与心理健康症状之间的纵向重叠在很大程度上是由抑郁症状(r = 0.15-0.24: 82-84% A, 11-12% C, and 5-6% E)和精神病样经历(r = 0.13-0.15: 81-91% A, 0-8% C, and 9-11% E)的遗传影响所解释的,但行为问题(r = 0.13-0.16; 0-42% A, 42-81% C, 16-24% E)则不是。我们的研究结果强调,社会隔离与其说是一种风险因素或结果,不如说是与心理健康状况不佳交织在一起的病因。对社会隔离的综合评估可以作为青少年潜在心理健康症状的一个有用指标。
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引用次数: 0
Prevalence of thiamine deficiency in anorexia nervosa: a systematic review and narrative synthesis. 神经性厌食症中硫胺素缺乏症的患病率:系统综述和叙述性综述。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-06 DOI: 10.1007/s00787-024-02576-7
Michael O'Brien, Rachael Quirke, Roisin Gowan, Fiona McNicholas

Thiamine is an essential vitamin that plays a crucial role in many biochemical processes in the body. Anorexia nervosa (AN) is one potential cause of a state of deficiency which can result in grave medical sequelae. There is limited available evidence of the prevalence of thiamine deficiency in patients who suffer from AN. The current study aimed to systematically review all available evidence on the prevalence of thiamine deficiency in cohorts with AN. Studies were included where thiamine status in a group of participants with AN was measured, either through self-reporting or objective measurement. Eight databases (Scopus, CINAHL complete, Medline complete, EMBASE, WEB OF SCIENCE, PROSPERO, COCHRANE DATABASE OF SYSTEMATIC REVIEWS and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. PRISMA guidelines were followed. The study was registered on PROSPERO. A minimum of two researchers conducted each part of the review. The search identified 42 articles whose full texts were screened for eligibility, with 17 retained for qualitative synthesis. The prevalence rates of thiamine deficiency in AN varied from 5.9% to 100% when based on self-report dietary intake. When objective measurements were taken, rates ranged from 0% to 56.7%. The review suggested that age, body mass index (BMI), duration of illness and subtype of AN were not associated with thiamine status. The limited available evidence suggested that the use of supplements, prior treatment and higher energy intakes were associated with a reduced risk of developing a thiamine deficiency among individuals with AN. Poor study methodology including small sample size, inconsistent deficiency definition and study heterogeneity limits the conclusions that can be drawn. Ultimately, there is insufficient strength of evidence to draw definitive clinical recommendations. This review highlights the need for further studies with more robust methodology to help further inform clinical practice.

硫胺素是一种人体必需的维生素,在体内许多生化过程中发挥着至关重要的作用。神经性厌食症(AN)是导致硫胺素缺乏的一个潜在原因,而硫胺素缺乏可能导致严重的医疗后遗症。关于神经性厌食症患者中硫胺素缺乏症发病率的现有证据十分有限。目前的研究旨在系统性地回顾所有关于AN患者群体中硫胺素缺乏症发生率的现有证据。研究纳入了通过自我报告或客观测量对一组AN患者的硫胺素状态进行测量的研究。共检索了八个数据库(Scopus、CINAHL complete、Medline complete、EMBASE、WEB OF SCIENCE、PROSPERO、COCHRANE DATABASE OF SYSTEMATIC REVIEWS 和 Cochrane Central Register of Controlled Trials (CENTRAL))。研究遵循 PRISMA 指南。研究已在 PROSPERO 上注册。每部分的综述至少由两名研究人员进行。此次检索共发现 42 篇文章,对其全文进行了资格筛选,并保留了 17 篇文章进行定性综合。根据自我报告的膳食摄入量,苯丙胺缺乏症的发病率从5.9%到100%不等。在进行客观测量时,发病率从0%到56.7%不等。综述表明,年龄、体重指数(BMI)、病程和AN亚型与硫胺素状态无关。有限的现有证据表明,使用补充剂、接受过治疗和摄入较多能量与降低AN患者发生硫胺素缺乏症的风险有关。研究方法不当,包括样本量小、缺乏症定义不一致以及研究的异质性,都限制了可以得出的结论。最终,由于证据不足,无法得出明确的临床建议。本综述强调了进一步研究的必要性,这些研究应采用更可靠的方法,以帮助进一步指导临床实践。
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引用次数: 0
Vortioxetine in children and adolescents with major depressive disorder: 6-month and 18-month open-label, flexible-dose, long-term extension studies. 伏替西汀治疗儿童和青少年重度抑郁症:为期 6 个月和 18 个月的开放标签、灵活剂量、长期扩展研究。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-06 DOI: 10.1007/s00787-024-02560-1
Melissa P DelBello, Robert L Findling, Michael Huss, Oscar Necking, Maria L Petersen, Simon N Schmidt, Monika Rosen

Children and adolescents with severe or relapsing major depressive disorder (MDD) may require long-term antidepressant use, but safety and tolerability data on long-term treatment are limited. In a randomized, placebo-controlled trial in children and another in adolescents, vortioxetine and placebo groups showed improvement in MDD symptoms without statistically significant differences between groups. To gain insights on long-term safety and tolerability of vortioxetine in pediatric patients, participants from these two studies were enrolled in two long-term extension studies: 6 months (NCT02871297) followed by another 18 months (NCT03108625). Key safety measures included adverse events (AEs) and Columbia-Suicide Severity Rating Scale (C-SSRS); effectiveness measures included depression symptom severity, cognitive function, and overall functioning. Among the 662 patients in the 6-month extension, 61% experienced a treatment-emergent AE (TEAE), with the most common being nausea (20.8%); 2.1% had a serious AE (SAE), and 6% withdrew because of TEAEs. In the following 18-month extension (n = 94), 51% of patients experienced a TEAE, with the most common being headache (13.8%); no SAEs were reported. Based on the C-SSRS, 94% and 96% of patients reported no suicidal ideation or behavior in the 6- and 18-month studies, respectively. During the extension studies, patients continued to show improvement in depressive symptoms and cognitive and overall functioning, with > 50% of patients in remission at the end of each study, regardless of study treatment in the lead-in trial. Overall, vortioxetine remained well tolerated in pediatric patients with MDD who continued in the long-term extension studies with no observed increased risk in suicidal ideation.

患有严重或复发性重度抑郁症(MDD)的儿童和青少年可能需要长期服用抗抑郁药,但有关长期治疗的安全性和耐受性数据却很有限。在一项针对儿童的随机安慰剂对照试验和另一项针对青少年的随机安慰剂对照试验中,伏替西汀组和安慰剂组均显示重度抑郁症状有所改善,但组间差异无统计学意义。为了深入了解伏替西汀在儿童患者中的长期安全性和耐受性,这两项研究的参与者参加了两项长期扩展研究:6个月(NCT02871297)和18个月(NCT03108625)。主要安全性指标包括不良事件(AEs)和哥伦比亚自杀严重程度量表(C-SSRS);有效性指标包括抑郁症状严重程度、认知功能和整体功能。在 6 个月的延长期中,662 名患者中有 61% 出现了治疗突发 AE(TEAE),其中最常见的是恶心(20.8%);2.1% 出现了严重 AE(SAE),6% 因 TEAE 而退出治疗。在随后为期 18 个月的延长治疗中(n = 94),51% 的患者出现了 TEAE,最常见的是头痛(13.8%);没有 SAE 报告。根据C-SSRS,在6个月和18个月的研究中,分别有94%和96%的患者没有自杀意念或行为。在延长期研究中,患者的抑郁症状、认知功能和整体功能继续得到改善,在每项研究结束时,均有超过 50% 的患者病情得到缓解,与先导试验中的治疗方法无关。总体而言,伏替西汀在儿童多发性抑郁症患者中仍具有良好的耐受性,这些患者继续接受了长期的延伸研究,且未观察到自杀意念风险的增加。
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引用次数: 0
Periaqueductal gray subregions connectivity and its association with micturition desire-awakening function. 输导管周围灰质亚区的连通性及其与排尿欲望唤醒功能的关系
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-05 DOI: 10.1007/s00787-024-02574-9
Shaogen Zhong, Xindi Lin, Mengxing Wang, Yi Mao, Jiayao Shen, Xiaoxia Du, Lichi Zhang, Jun Ma

Existing literature strongly supports the idea that children with primary nocturnal enuresis (PNE) have brainstem abnormalities. However, the connection between pre-micturition arousal responses and brain functional connectivities is still not clearly defined. Our study investigated the correlation between the gradations of micturition desire-awakening (MDA) functionality and the functional connectivity of the midbrain periaqueductal gray (PAG), a pivotal brainstem hub implicated in the neural regulation of micturition in humans. Neuroimaging and behavioral data from 133 patients with PNE and 40 healthy children were acquired from functional magnetic resonance imaging (fMRI) and precise clinical observations, respectively. The whole-brain correlation analyses were undertaken to elucidate the complex connectivity patterns between the subregions of PAG and the cerebral cortex, with a focus on their correlation to the spectrum of MDA functionality. A positive correlation was identified between MDA dysfunction and the resting-state functional connectivity (RSFC) between the left ventrolateral periaqueductal gray (vlPAG) and the right temporal pole of the superior temporal gyrus. Conversely, a negative correlation was observed between MDA dysfunction and the RSFC of the right vlPAG with the right superior parietal lobule. Additionally, MDA dysfunction exhibited a negative association with the RSFC between the dorsomedial PAG (dmPAG) and the right inferior parietal lobule. These findings may indicate that the specific signal from a distended bladder is blocked in the PAG and its functional connectivity with the executive function, attention, and default mode networks, ultimately leading to impaired arousal and bladder control. This revelation underscores potential neural targets for future therapeutic interventions.

现有文献有力地支持了原发性夜间遗尿症(PNE)患儿脑干异常的观点。然而,排尿前唤醒反应与大脑功能连接之间的联系仍未明确界定。我们的研究调查了排尿欲望唤醒(MDA)功能的分级与中脑咽鼓管周围灰(PAG)功能连接之间的相关性。研究人员通过功能磁共振成像(fMRI)和精确的临床观察,分别获得了133名PNE患者和40名健康儿童的神经影像学和行为学数据。全脑相关性分析旨在阐明 PAG 亚区与大脑皮层之间复杂的连接模式,重点关注其与 MDA 功能谱的相关性。研究发现,MDA功能障碍与左侧腹外侧uctal灰质(vlPAG)和颞上回右颞极之间的静息态功能连接(RSFC)呈正相关。相反,MDA 功能障碍与右侧 vlPAG 和右侧顶叶上部的 RSFC 之间呈负相关。此外,MDA 功能障碍与背内侧 PAG(dmPAG)和右下顶叶之间的 RSFC 呈负相关。这些发现可能表明,来自膀胱膨胀的特定信号在 PAG 及其与执行功能、注意力和默认模式网络的功能连接中受阻,最终导致唤醒和膀胱控制受损。这一发现强调了未来治疗干预的潜在神经靶点。
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引用次数: 0
ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents. 与青少年自伤想法和行为有关的多动症和认知分离综合征症状。
IF 6 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-05 DOI: 10.1007/s00787-024-02556-x
Keely E Thornton, Kelsey K Wiggs, Jeffery N Epstein, Leanne Tamm, Stephen P Becker

The current study examined attention-deficit/hyperactivity disorder (ADHD) dimensions and cognitive disengagement syndrome (CDS) symptoms in relation to self-injurious thoughts and behaviors (SITBs) in an early adolescent sample. Participants were 341 adolescents ages 10-12 years (52.2% female; 37.8% people of color) recruited from the community. Caregivers reported on CDS and ADHD symptoms. Adolescents completed a rating scale and were administered an interview assessing SITBs. We estimated associations using logistic regression in a stepped fashion: (1) no adjustment, (2) adjustment for sex, race, family income, and psychotropic medication use, and (3) further adjustment for depressive symptoms. In this early adolescent community sample, 22.9% reported a history of suicidal ideation, 8.2% reported a history of a suicide plan, 6.2% reported a history of non-suicidal self-injury (NSSI), and 16.4% met a clinical cutoff for current suicide risk. Across most analyses using rating scale or interview methods, higher mean CDS scores were related to endorsement of suicidal ideation and planning. ADHD inattentive (IN) and hyperactive-impulsive (HI) symptoms were associated with endorsement of NSSI, and ADHD-IN symptoms were associated with thoughts of suicide and/or plan measured via questionnaire, though effects were less robust and not significant, potentially due to low base rates impacting statistical power. This study adds to a growing body of research highlighting the importance of screening for CDS symptoms among individuals with and without ADHD. More research, especially longitudinal work, is needed that examines possible differential pathways to SITBs by ADHD and CDS symptoms to advance SITB prevention, early detection, and intervention.

本研究调查了青少年早期样本中注意力缺陷/多动障碍(ADHD)症状和认知分离综合征(CDS)症状与自伤想法和行为(SITBs)的关系。研究对象是从社区招募的 341 名 10-12 岁青少年(52.2% 为女性;37.8% 为有色人种)。照顾者报告了CDS和ADHD症状。青少年填写了评分量表,并接受了评估 SITBs 的访谈。我们采用逻辑回归法对相关性进行了分步估计:(1) 不做调整;(2) 对性别、种族、家庭收入和精神药物使用情况进行调整;(3) 进一步对抑郁症状进行调整。在这一青少年社区样本中,22.9%的人有自杀意念史,8.2%的人有自杀计划史,6.2%的人有非自杀性自伤(NSSI)史,16.4%的人符合当前自杀风险的临床临界值。在使用评分量表或访谈方法进行的大多数分析中,CDS平均得分越高,说明越认可自杀意念和计划。注意力不集中型多动症(ADHD inattentive,IN)和多动冲动型多动症(Hyperactive-impulsive,HI)症状与NSSI认同相关,而ADHD-IN症状与通过问卷调查测量的自杀想法和/或计划相关,但影响并不显著,这可能是由于低基数影响了统计能力。这项研究为越来越多的研究增添了新的内容,这些研究强调了在有或没有多动症的人群中筛查 CDS 症状的重要性。我们需要开展更多的研究,尤其是纵向研究,根据多动症和 CDS 症状来检查可能导致 SITB 的不同途径,以促进 SITB 的预防、早期发现和干预。
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引用次数: 0
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European Child & Adolescent Psychiatry
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