European Psychiatry最新文献

Background: Suicide remains a major risk factor for individuals suffering from schizophrenia and its prodromal state (i.e., Ultra-High Risk for Psychosis). However, less is known about the prevalence of suicidal behaviour among the adolescent and youth UHR population, a demographic vulnerable to the psychosocial and environmental risk factors of suicide. This review aims to synthesise existing literature on the prevalence of suicidal ideation and behaviour in the adolescent and youth at Ultra-High Risk for Psychosis (UHR), and the associations between suicidal behaviour and its correlates.

Methods: The databases PsycINFO, PubMed, Embase, Cochrane Library, Web of Science, and Scopus were accessed up to July 2024. A meta-analysis of prevalence was subsequently performed for lifetime suicidal ideation, lifetime non-suicidal self-injury, lifetime suicidal attempt, and current suicidal ideation. A narrative review was also carried out for the correlates of suicidal behaviour amongst adolescents and youth in the UHR population.

Results: Studies were included in this meta-analysis. Meta-analysis revealed a high prevalence of lifetime suicidal ideation (58%), lifetime non-suicidal self-injury (37%), lifetime suicidal attempt (25%), and current (2 week) suicidal ideation (56%). The narrative review revealed that a personal transition to psychosis and a positive family history of psychosis were associated with suicidal attempts, while depression was associated with both suicidal attempts and suicidal ideation.

Conclusion: The prevalence of suicidal ideation and behaviour among UHR adolescents and youth is high and comparable to that of the general UHR population. Existing measures that mitigate suicide risk in the general UHR population should be adopted for the youth context.

Background: The mental health of incarcerated individuals is a widely recognized public health issue, but little is known about the mental health status of the incarcerated individuals upon release. This study aimed to measure the prevalence of psychiatric disorders and substance use disorders (SUDs) among incarcerated men scheduled to be released from jail soon.

Methods: We conducted a cross-sectional national survey from September 2020 to September 2022 across 26 jails (selected at random) in France. Each participant was interviewed within 30 days prior to their release via a structured questionnaire, including the Mini International Neuropsychiatric Interview.

Results: A total of 579 individuals were included in the analysis (participation rate: 66.2%). The prevalence of mood disorders, anxiety disorders, post-traumatic stress disorder, and psychotic episodes were 30.7% (95% confidence interval [CI]: 27.1%-34.6%), 28.7% (95% CI: 25.1%-32.5%), 11.1% (95% CI: 8.8%-13.9%), and 10.5% (95% CI: 8.3%-13.3%), respectively. Additionally, almost half of the individuals had an SUD, and dual disorders were identified in 21.9% (95% CI: 18.8%-25.5%) of the cases. The analysis of mental health care pathways raised questions about access to certain types of care, such as full-time psychiatric hospitalization while in prison, as well as questions about the continuity of care upon release.

Conclusions: This study shows that the mental health of incarcerated men who are scheduled to be released soon is precarious. Complex mental health problems, particularly dual disorders, are common and require better coordination between mental health care systems in prisons and the community.

Background: Catatonia in psychotic patients presents unique challenges. While antipsychotics are the cornerstone of schizophrenia treatment, their use in catatonic patients is sometimes discouraged for fear of worsening the signs. Reports on the successful use of second-generation antipsychotics have been published. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to describe the outcomes of antipsychotic-treated catatonic events.

Methods: We searched Medline and Web of Science databases from 2000 to 2023 using search terms including "catatonia" and "antipsychotic agents" for all original peer-reviewed articles, including clinical trials, observational studies, and case-reports. We included antipsychotic-treated catatonic events and extracted data on patient characteristics, pharmacological context, agent involved, and treatment outcomes for each antipsychotic trial.

Results: After screening 6,219 records, 79 full-text articles were included. Among them, we identified 175 antipsychotic trials (in 110 patients). Only 41.1% of the patients benefited from a previous benzodiazepine trial. Antipsychotic use was considered beneficial in 60.0% of the trials, neutral in 29.1%, and harmful in 10.9%. Trials tended to be reported as beneficial for amisulpride, clozapine, and risperidone, equivocal for aripiprazole and olanzapine, and mostly detrimental for haloperidol and quetiapine. Psychotic disorders were the most common underlying etiology (65.8%).

Conclusions: Antipsychotics could be an option in the treatment of catatonia in psychotic patients. However, with few exceptions, we found non-beneficial outcomes with all second-generation antipsychotics in varying proportions in this largest review to date. Although olanzapine is widely used, it is associated with mitigated reported outcomes.

Background: It is widely known that people with a severe and persistent mental illness (SPMI) are more at risk of poor physical health outcomes because of disparities in healthcare access and provision. Less is known about the quality of end-of-life (EoL) care in people with SPMI who have a life-limiting disease.

Methods: A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on EoL care and/or palliative sedation for people with SPMI and a life-limiting disease. A critical appraisal of the selected reviews was performed. Data were analyzed according to the four principles of biomedical ethics.

Results: Ten reviews were included. These show that people with SPMI are at risk of suboptimal EoL care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL care for people with SPMI. No data were found about palliative sedation.

Conclusions: To optimize palliative and EoL care for SPMI patients with a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL particularly on palliative sedation for people with SPMI and a life-limiting disease.

Background: The prevalence of alcohol use disorder among older adults is increasing, with this population being particularly vulnerable to alcohol's detrimental effects. While knowledge of preventative factors is scarce, physical activity has emerged as a potential modifiable protective factor. This study aimed to examine associations between alcohol consumption and physical activity in a large-scale, multi-national prospective study of the older adult population.

Methods: Longitudinal data from the SHARE study on physical activity, alcohol consumption, demographic, socioeconomic, and health variables, were analyzed in older adults. Individual-level data were examined using logistic regression models. Both cross-sectional and longitudinal models were calculated to account for potential latency in the association between physical activity and alcohol consumption.

Results: The study included 3133 participants from 13 countries. Higher physical activity levels were significantly associated with higher alcohol consumption in cross-sectional (p = 0.0004) and longitudinal analyses (p = 0.0045) over a median follow-up of 6 years. While the presence of depressive symptoms and higher educational attainment were associated with higher alcohol consumption, female sex and persons with lower perceived health showed lower frequency of alcohol consumption. Additionally, the country of residence also proved to be a relevant factor for alcohol consumption.

Conclusions: Higher levels of physical activity showed an association with higher alcohol consumption in older adults. Future research should investigate whether this association is causal and underpinned by neurobiological, social, or methodological factors.

Background: Depression affects twice as many women as men. Risk factors for depression certainly impact this difference, but their strong interconnectedness challenges the assessment of standalone contributions. Network models allow the identification of systematic independent relationships between individual symptoms and risk factors. This study aimed to evaluate whether the extended networks of depressive symptoms, cognitive functions, and leisure activities in like-sex twins differ depending on gender or zygosity.

Methods: Twins, including 2,040 women (918 monozygotic and 1,122 dizygotic) and 1,712 men (730 monozygotic and 982 dizygotic), were selected from the Danish Twin Registry for having, along with their like-sex co-twin, completed measures of depressive symptoms, cognition, and leisure activities (physical, intellectual, and social). Network models were estimated and compared at three levels: co-twins to each other within groups defined by gender and zygosity; monozygotic to dizygotic twins within the same gender, and between genders.

Results: No significant differences were observed when co-twins were compared to each other, regardless of the pair's zygosity or gender, nor when monozygotic twins were compared to dizygotic twins within gender. However, the gendered networks differed significantly in global strength, structure, and partial correlations between specific depressive symptoms and risk factors, all indicating stronger connectedness in women relative to men.

Conclusions: Environmental factors appear to best explain between-gender network differences. Women's networks showed significantly stronger associations both among depressive symptoms and between depressive symptoms and risk factors (i.e., decreased cognition and leisure activities). Longitudinal research is needed to determine the causality and directionality of these relationships.

Background: Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022.

Methods: Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages.

Results: A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences.

Conclusions: Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.

Background: Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal ideation. We piloted a randomized, double-blind, sham-controlled trial of bilateral rTMS for patients with OUD and MDD experiencing suicidality.

Methods: Sequential bilateral TBS was delivered guided by structural neuroimaging: continuous TBS to the right then intermittent TBS to the left DLPFC, daily (20 treatments). The primary objective was to determine the feasibility of this population. The primary clinical outcome was the scale for suicidal ideation (SSI), secondary outcomes included depressive symptoms and opioid cue-induced craving. ClinicalTrials.gov: NCT04785456.

Results: Eighty-seven individuals were pre-screened. The most common reasons for ineligibility included being unreachable by the study team, difficulty with scheduling/travel requirements, and medical/psychiatric instability. Six participants (5:1 M:F) were enrolled (3/arm), four had a fentanyl use history; two completed per protocol (1/arm). Of the participants with follow-up data, SSI scores decreased in 2/3 in the sham arm and 2/2 in the active arm; depression and opioid craving scores decreased in all participants.

Conclusion: We present the first data piloting a structural neuroimaging-guided, multi-session rTMS treatment course in outpatients with suicidality and OUD in the current North American context. Recruitment and retention were the main challenges given the highly unstable medical and psychosocial context of this patient population. Future trials should consider a suitable environment to improve the feasibility of delivering this treatment.

Introduction: Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance.

Methods: The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023.

Results: Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results.

Conclusions: Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.