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Stigma and health: an urgent need in the training of health professionals 耻辱与健康:迫切需要培训卫生专业人员。
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 DOI: 10.1016/j.genhosppsych.2025.10.019
Matías E. Rodríguez-Rivas , Sanndy Infante
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引用次数: 0
Efficacy and safety of quetiapine prophylaxis for delirium in hospitalized adult patients: A systematic review and meta-analysis of randomized controlled trials 奎硫平预防住院成年患者谵妄的疗效和安全性:随机对照试验的系统回顾和荟萃分析
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-21 DOI: 10.1016/j.genhosppsych.2025.10.011
Raj Kiran Donthu , Sneha Mary Minz , Mamidipalli Sai Spoorthy , R. Dyuthy , A. Balaji , P.S. Sethu , Libnus B. Varghese , Shahul Ameen , Brijesh Sathian , Vikas Menon

Objective

We aimed to compare summary estimates of efficacy and safety of quetiapine versus comparator treatments in preventing delirium among hospitalized adult patients by pooling evidence from parallel-group randomized controlled trials (RCTs).

Methods

We searched MEDLINE, Embase, Scopus, and clinical trial registers from inception till January 31st, 2025. Our primary outcome was between-group incidence of delirium. Secondary outcomes included 10-day mortality, duration of hospital stay, duration of delirium, severity of delirium, readmission rates (efficacy outcomes), and reported adverse effects (safety outcomes).

Results

Six eligible RCTs (pooled N = 491) were identified; of these, five were included in the meta-analysis. The pooled RR for preventing the incidence of delirium was 0.61 (95 % CI, 0.45–0.83;5 RCTs; I2 = 0;p = .001), favoring quetiapine (dose range 12.5-75 mg/day). The SMD for duration of delirium was −1.21 (95 % CI, −2.08 to −0.35; 3 RCTs; I2 = 86 %; p = .006), again favoring quetiapine. No significant between-group differences were noted on other outcomes. Adverse effects with quetiapine were absent in four studies and minimal in the other two. The findings were robust to sensitivity analyses.

Conclusion

Low-dose quetiapine prophylaxis may be a safe and effective treatment option for preventing delirium. These conclusions are tempered by the small number and size of existing trials.
目的:我们旨在通过汇集平行组随机对照试验(rct)的证据,比较奎硫平与比较药物治疗在预防住院成年患者谵妄方面的有效性和安全性的总结估计。方法:检索MEDLINE、Embase、Scopus和临床试验注册库,检索时间从成立到2025年1月31日。我们的主要结局是组间谵妄的发生率。次要结局包括10天死亡率、住院时间、谵妄持续时间、谵妄严重程度、再入院率(疗效结局)和报告的不良反应(安全性结局)。结果:共纳入6项符合条件的rct(共N = 491);其中5例纳入meta分析。预防谵谵症发生率的合并RR为0.61 (95% CI, 0.45-0.83;5个rct; I2 = 0;p = .001),支持喹硫平(剂量范围12.5-75 mg/天)。谵妄持续时间的SMD为-1.21 (95% CI, -2.08至-0.35;3个rct; I2 = 86%; p = 0.006),再次有利于喹硫平。其他结果组间无显著差异。四项研究没有喹硫平的不良反应,另外两项研究的不良反应最小。这些发现在敏感性分析中是稳健的。结论:低剂量喹硫平预防谵妄可能是一种安全有效的治疗选择。这些结论受到现有试验数量和规模较小的影响。
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引用次数: 0
Cognitive function among stable schizophrenia patients receiving an mHealth app-based cognitive remediation therapy: randomized controlled trial with mediation analysis 接受基于移动健康应用程序的认知修复治疗的稳定型精神分裂症患者的认知功能:随机对照试验与中介分析
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-22 DOI: 10.1016/j.genhosppsych.2025.10.013
Min Wen , Xiaoyao Liu , Ying He , Weiguo Xu , Yongling Zhou , Juan Liu , Xiaodan Zhu

Objective

To explore the application effect and underlying mechanisms of mHealth app-based cognitive remediation therapy on the cognitive function of patients with stable schizophrenia.

Methods

This study was a randomized controlled trial, patients received either treatment as usual or mHealth app-based cognitive remediation therapy. Guided by the theoretical framework integrating the MCI theoretical model of rehabilitation, we examined the mediating roles of self-efficacy and negative emotion in the relationship between intervention subgroups and cognitive functioning. These outcome indicators were assessed at baseline, the primary endpoint, and the follow-up endpoint. Linear mixed-effects modeling was employed to compare these measures between the two patient groups, with all analyses adhering to the intention-to-treat principle. Mediation analyses were conducted using the PROCESS. The significance of mediation effects was assessed through bias-corrected nonparametric percentile bootstrap analysis.

Results

Linear mixed-effects models revealed statistically significant group*time interaction effects at both the primary endpoint (post-intervention) and the follow-up endpoint (3-month post-intervention) for cognitive functioning (P = 0.001), psychiatric symptoms (P < 0.001), self-efficacy (P < 0.001), and negative emotions (P < 0.001). Analysis of these interactions indicated that, compared to the TAU group, the CRT group demonstrated significantly greater improvement in cognitive function and self-efficacy, and significantly greater reduction in psychiatric symptoms and negative emotions over time. Mediation analyses further indicated that self-efficacy scores partially mediated the relationship between the intervention groupings and cognitive function scores (indirect effect of 0.237, 95 % CI [0.073, 0.414]). Similarly, negative emotion scores were found to partially mediate this relationship (indirect effect of 0.154, 95 % CI [0.029, 0.323]).

Conclusion

Cognitive remediation therapy delivered through mHealth app for patients with stable schizophrenia has been shown to effectively improve cognitive functioning. Moreover, this intervention may exert an indirect positive effect on cognitive performance mediated by negative emotions and self-efficacy.
目的:探讨基于移动健康app的认知修复疗法对稳定型精神分裂症患者认知功能的应用效果及其机制。方法:本研究是一项随机对照试验,患者接受常规治疗或基于移动健康应用程序的认知修复治疗。在整合MCI康复理论模型的理论框架指导下,我们考察了自我效能感和负性情绪在干预亚组与认知功能关系中的中介作用。这些结局指标在基线、主要终点和随访终点进行评估。采用线性混合效应模型比较两组患者的这些措施,所有分析均遵循意向治疗原则。使用PROCESS进行中介分析。通过偏差校正的非参数百分位自举分析评估中介效应的显著性。结果:线性混合效应模型显示,在主要终点(干预后)和随访终点(干预后3个月),认知功能(P = 0.001)和精神症状(P)方面,组*时间交互作用具有统计学意义(P = 0.001)。结论:通过移动健康应用程序对稳定型精神分裂症患者进行认知修复治疗已被证明可以有效改善认知功能。此外,这种干预可能对负性情绪和自我效能介导的认知表现产生间接的积极影响。
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引用次数: 0
Social factors related to untreated post stroke depression 未治疗脑卒中后抑郁的社会因素
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-09-24 DOI: 10.1016/j.genhosppsych.2025.09.007
Alexandra Balshi , John Dempsey , Matthew Z. Farber , Adam Jiadi , Harish Babu
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引用次数: 0
Association between COVID-19 infection and risk of mental disorders: a systematic review and meta-analysis COVID-19感染与精神障碍风险之间的关联:系统综述和荟萃分析。
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-10 DOI: 10.1016/j.genhosppsych.2025.10.008
Jiayi Liu , Honghao Lai , Weilong Zhao , Jiajie Huang , Bei Pan , Janne Estill , Long Ge

Objective

To systematically review and meta-analyse the association between COVID-19 and the risk of mental disorders.

Methods

We searched PubMed, Embase, CINAHL, PsycINFO, and the reference lists of systematic reviews and included cohort studies assessing the association between COVID-19 and mental disorders. Two reviewers independently performed literature screening, data extraction, and the risk of bias assessment. We conducted a random-effect meta-analysis to assess the association and calculated the pooled risk ratio with 95 % confidence interval.

Results

Twenty-eight cohorts with a total of 977,434,207 participants proved eligible. We revealed a 40 % increased risk (RR = 1.40, 95 %CI: 1.23 to 1.59; absolute risk difference = 31 more per 1000 persons, 18 more to 45 more) of mental disorders in patients with COVID-19 compared with non-exposed individuals. Moreover, COVID-19 may be related to the risks of anxiety or fear-related disorders, mood disorders, bipolar or related disorders, depressive disorders, unspecified mood disorders, neurocognitive disorders, dementia, mild cognitive disorders, unspecified neurocognitive disorders, psychotic disorders, stress and adjustment disorders, post-traumatic stress disorder, unspecified stress and adjustment disorders, and prescriptions for psychotropic medications.

Conclusions

Our findings suggest an association between COVID-19 and risk of mental disorders, as well as the prescriptions for psychotropic medications. It is imperative for individuals to become vigilant of mental health problems that may arise following COVID-19.
目的:系统回顾和荟萃分析COVID-19与精神障碍风险的关系。方法:检索PubMed、Embase、CINAHL、PsycINFO和系统评价的参考文献列表,并纳入评估COVID-19与精神障碍之间关系的队列研究。两名审稿人独立进行文献筛选、数据提取和偏倚风险评估。我们进行了随机效应荟萃分析来评估相关性,并以95%的置信区间计算了合并风险比。结果:28个队列共977,434,207名参与者被证明符合条件。我们发现,与未暴露的个体相比,COVID-19患者患精神障碍的风险增加了40% (RR = 1.40, 95% CI: 1.23至1.59;绝对风险差=每1000人多31人,18至45人)。此外,COVID-19可能与以下风险有关:焦虑或恐惧相关障碍、情绪障碍、双相情感障碍或相关障碍、抑郁症、未指明的情绪障碍、神经认知障碍、痴呆、轻度认知障碍、未指明的神经认知障碍、精神障碍、压力和适应障碍、创伤后应激障碍、未指明的压力和适应障碍以及精神药物处方。结论:我们的研究结果表明,COVID-19与精神障碍风险以及精神药物处方之间存在关联。个人必须对COVID-19后可能出现的心理健康问题保持警惕。
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引用次数: 0
Key competencies for psychedelic treatment in real-world mental health care settings 在现实世界的精神卫生保健设置致幻剂治疗的关键能力。
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-09-16 DOI: 10.1016/j.genhosppsych.2025.09.003
Max Wolff , Hans Rutrecht , Gerhard Gründer , Andrea Jungaberle , Henrik Jungaberle
Psychedelic treatments are extending beyond research units and into hospitals, outpatient clinics, and community practices. Contrasting the constrained procedures of clinical trials with the realities of routine practice, this article outlines the competencies needed for safe, effective, and ethically sound psychedelic therapy in everyday mental health care. To accommodate mainstream adoption of these treatments, the competencies framework we present respects the distinctive contextual and cultural sensitivities of psychedelic care while remaining anchored in established psychotherapeutic, medical, and scientific paradigms. Designed for varied service models, the framework is substance-unspecific (i.e., covering various classical and atypical psychedelic agents) and transtheoretical (i.e., compatible with cognitive-behavioral, psychodynamic, humanistic-experiential, systemic and other psychotherapeutic orientations). Developed within the MIND Foundation's Augmented Psychotherapy Training (APT) program, the framework spans foundational psychotherapeutic, biomedical, philosophical, socio-cultural, existential, legal, and self-experiential domains and translates them into practical competencies for multi-professional cooperation, screening, preparation, dosing, integration, and harm-reduction. While the framework awaits systematic evaluation across diverse clinical contexts, it offers an initial blueprint for future accredited certification pathways and for the ongoing refinement of clinician training as these treatments enter mainstream care.
迷幻药的治疗已经从研究单位扩展到医院、门诊诊所和社区实践。对比临床试验的约束程序与常规实践的现实,本文概述了在日常精神卫生保健中安全、有效和合乎伦理的迷幻治疗所需的能力。为了适应这些治疗的主流采用,我们提出的能力框架尊重迷幻治疗的独特背景和文化敏感性,同时保持在已建立的心理治疗,医学和科学范式中。该框架针对不同的服务模式而设计,是物质非特异性的(即涵盖各种经典和非典型迷幻剂)和跨理论的(即兼容认知-行为,心理动力学,人文-经验,系统和其他心理治疗方向)。该框架是在MIND基金会的增强心理治疗培训(APT)项目中开发的,涵盖了基本的心理治疗、生物医学、哲学、社会文化、存在主义、法律和自我体验领域,并将其转化为多专业合作、筛选、准备、剂量、整合和减少伤害的实用能力。虽然该框架有待在不同的临床环境中进行系统评估,但它为未来认可的认证途径和随着这些治疗进入主流护理而不断改进的临床医生培训提供了初步蓝图。
{"title":"Key competencies for psychedelic treatment in real-world mental health care settings","authors":"Max Wolff ,&nbsp;Hans Rutrecht ,&nbsp;Gerhard Gründer ,&nbsp;Andrea Jungaberle ,&nbsp;Henrik Jungaberle","doi":"10.1016/j.genhosppsych.2025.09.003","DOIUrl":"10.1016/j.genhosppsych.2025.09.003","url":null,"abstract":"<div><div>Psychedelic treatments are extending beyond research units and into hospitals, outpatient clinics, and community practices. Contrasting the constrained procedures of clinical trials with the realities of routine practice, this article outlines the competencies needed for safe, effective, and ethically sound psychedelic therapy in everyday mental health care. To accommodate mainstream adoption of these treatments, the competencies framework we present respects the distinctive contextual and cultural sensitivities of psychedelic care while remaining anchored in established psychotherapeutic, medical, and scientific paradigms. Designed for varied service models, the framework is substance-unspecific (i.e., covering various classical and atypical psychedelic agents) and transtheoretical (i.e., compatible with cognitive-behavioral, psychodynamic, humanistic-experiential, systemic and other psychotherapeutic orientations). Developed within the MIND Foundation's Augmented Psychotherapy Training (APT) program, the framework spans foundational psychotherapeutic, biomedical, philosophical, socio-cultural, existential, legal, and self-experiential domains and translates them into practical competencies for multi-professional cooperation, screening, preparation, dosing, integration, and harm-reduction. While the framework awaits systematic evaluation across diverse clinical contexts, it offers an initial blueprint for future accredited certification pathways and for the ongoing refinement of clinician training as these treatments enter mainstream care.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"97 ","pages":"Pages 11-24"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is intranasal esketamine versus intravenous ketamine a therapeutic innovation or a divide in access to care? 鼻用艾氯胺酮与静脉注射氯胺酮是一种治疗创新还是在获得护理方面的分歧?
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-10 DOI: 10.1016/j.genhosppsych.2025.10.005
Yassine Benhaddouch, Adil El Ammouri
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引用次数: 0
Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression 裸盖菇素辅助治疗的设置和设置:癌症和抑郁症患者的定性研究。
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-11 DOI: 10.1016/j.genhosppsych.2025.10.010
Yvan Beaussant , Elise Tarbi , Kabir Nigam , Skye Miner , Zachary Sager , Justin Sanders , Michael Ljuslin , Benjamin Guérin , Roxanne Sholevar , Kimberly Roddy , James A. Tulsky , Manish Agrawal

Background

Psilocybin-assisted therapy (PAT) shows promise for cancer-related depression, yet little research has examined how therapeutic context shapes patient experiences. While set (mindset) and setting (environment) are considered central to psychedelic treatment, empirical evidence on their role in PAT acceptability remains limited. This study explores factors influencing the acceptability of PAT from the perspective of patients with cancer and depression.

Methods

We conducted semi-structured interviews with participants in a clinical trial of psilocybin-assisted therapy. Using template analysis, we examined themes related to the acceptability of the experience and the surrounding therapeutic environment.

Results

Participants (n = 28) described the psilocybin experience as intense and demanding, with therapeutic benefits closely tied to their ability to “surrender”—a term used to describe accepting and remaining open to the experience's intensity and unpredictability. A safe, supportive, and ethical environment was critical in fostering trust and engagement. Preparation and integration were key to maximizing benefit. Music played a significant but variable role, sometimes enhancing and other times distracting. While the clinical setting provided safety, ceremonial elements added meaning for many.

Conclusions

Findings highlight how therapeutic structure, preparation, and setting shape PAT acceptability, supporting the need for patient-centered approaches to optimize care and outcomes.
背景:裸盖菇素辅助疗法(PAT)显示出治疗癌症相关抑郁症的希望,但很少有研究调查治疗环境如何影响患者的经历。虽然设定(心态)和设定(环境)被认为是迷幻药治疗的核心,但关于它们在PAT可接受性中的作用的经验证据仍然有限。本研究从癌症和抑郁症患者的角度探讨影响PAT可接受性的因素。方法:我们对参与裸盖菇素辅助治疗临床试验的参与者进行了半结构化访谈。使用模板分析,我们检查了与经验的可接受性和周围治疗环境相关的主题。结果:参与者(n = 28)将裸盖菇素的体验描述为强烈而苛刻的,其治疗效果与他们“投降”的能力密切相关——这个术语用于描述接受并保持对体验的强度和不可预测性的开放态度。一个安全、支持和道德的环境对于促进信任和接触至关重要。准备和整合是实现效益最大化的关键。音乐发挥了重要但多变的作用,有时增强,有时分散。虽然临床环境提供了安全,但仪式元素为许多人增添了意义。结论:研究结果强调了治疗结构、准备和设置如何影响PAT的可接受性,支持以患者为中心的方法来优化护理和结果的需要。
{"title":"Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression","authors":"Yvan Beaussant ,&nbsp;Elise Tarbi ,&nbsp;Kabir Nigam ,&nbsp;Skye Miner ,&nbsp;Zachary Sager ,&nbsp;Justin Sanders ,&nbsp;Michael Ljuslin ,&nbsp;Benjamin Guérin ,&nbsp;Roxanne Sholevar ,&nbsp;Kimberly Roddy ,&nbsp;James A. Tulsky ,&nbsp;Manish Agrawal","doi":"10.1016/j.genhosppsych.2025.10.010","DOIUrl":"10.1016/j.genhosppsych.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Psilocybin-assisted therapy (PAT) shows promise for cancer-related depression, yet little research has examined how therapeutic context shapes patient experiences. While set (mindset) and setting (environment) are considered central to psychedelic treatment, empirical evidence on their role in PAT acceptability remains limited. This study explores factors influencing the acceptability of PAT from the perspective of patients with cancer and depression.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with participants in a clinical trial of psilocybin-assisted therapy. Using template analysis, we examined themes related to the acceptability of the experience and the surrounding therapeutic environment.</div></div><div><h3>Results</h3><div>Participants (<em>n</em> = 28) described the psilocybin experience as intense and demanding, with therapeutic benefits closely tied to their ability to “surrender”—a term used to describe accepting and remaining open to the experience's intensity and unpredictability. A safe, supportive, and ethical environment was critical in fostering trust and engagement. Preparation and integration were key to maximizing benefit. Music played a significant but variable role, sometimes enhancing and other times distracting. While the clinical setting provided safety, ceremonial elements added meaning for many.</div></div><div><h3>Conclusions</h3><div>Findings highlight how therapeutic structure, preparation, and setting shape PAT acceptability, supporting the need for patient-centered approaches to optimize care and outcomes.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"97 ","pages":"Pages 175-184"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The relationship between cognitive function and depressive symptoms in Chinese older adults: A cross-lagged panel network analysis 中国老年人认知功能与抑郁症状的关系:一个交叉滞后面板网络分析
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-11-01 Epub Date: 2025-10-26 DOI: 10.1016/j.genhosppsych.2025.10.016
Shuaichen Li , Jinglan Tan , Yanwei Guo , Junyao Li , Renqin Hu , Jiayi Ge , Yiran Feng , Wenjing Zhao , Qinghua Luo

Background

The bidirectional association between depressive symptoms and cognitive decline has been extensively studied in Western populations, yet empirical evidence from non-Western contexts, particularly among Chinese older adults, remains limited. This study aimed to examine the longitudinal and symptom-level dynamics between depressive symptoms and cognitive functioning using a cross-lagged panel network (CLPN) approach.

Methods

Data were drawn from two waves (2015, 2018) of the China Health and Retirement Longitudinal Study (CHARLS), including 6824 individuals aged 50 years and above. Cognitive performance was assessed via the China Mini-Mental State Examination (CMMSE), and depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression Scale (CESD-8). A CLPN model was estimated to identify temporally predictive pathways and symptom-level interactions, with LASSO regularization ensuring model sparsity. Model stability was evaluated through nonparametric bootstrapping.

Results

Findings revealed a reciprocal, predominantly negative relationship between cognitive decline and depressive symptoms over time. “Mental State” (orientation, processing, and visuospatial skills) emerged as the central network hub and primary bridge from cognition to depression, while lack of motivation (“ I felt everything was an effort”) was the pivotal bridge symptom from depression to cognition. Specifically, “I felt everything was an effort” predicted subsequent declines in memory function, whereas better mental state predicted reduced depressive symptoms, including feeling depressed, trouble concentrating, and restless sleep. The network model highlighted symptom-specific pathways not observable in traditional latent variable models.

Conclusions

This study underscores the clinical and public health value of integrated screening and interventions targeting both depressive symptoms and cognitive impairment in older adults. Motivational deficits and mental state deficits may serve as actionable transdiagnostic targets. Future interventions should be symptom-specific, modular, and culturally sensitive. Longitudinal neurobiological studies are warranted to elucidate underlying mechanisms.
背景:在西方人群中,抑郁症状与认知能力下降之间的双向关联已被广泛研究,但非西方背景下的经验证据,特别是在中国老年人中,仍然有限。本研究旨在使用交叉滞后面板网络(CLPN)方法检查抑郁症状和认知功能之间的纵向和症状水平动态。方法:数据来源于中国健康与退休纵向研究(CHARLS)的两波(2015年、2018年),共6824名50岁及以上的个体。通过中国简易精神状态检查(CMMSE)评估认知能力,使用8项流行病学研究中心抑郁量表(csd -8)测量抑郁症状。估计CLPN模型用于识别时间预测途径和症状水平的相互作用,使用LASSO正则化确保模型稀疏性。通过非参数自举评估模型的稳定性。结果:研究结果显示,随着时间的推移,认知能力下降和抑郁症状之间存在相互的、主要为负的关系。“精神状态”(定向、处理和视觉空间技能)是认知到抑郁的中心网络枢纽和主要桥梁,而缺乏动机(“我觉得一切都是努力”)是从抑郁到认知的关键桥梁症状。具体来说,“我觉得一切都是一种努力”预示着随后记忆功能的下降,而更好的精神状态预示着抑郁症状的减少,包括情绪低落、注意力难以集中和睡眠不安。网络模型强调了传统潜在变量模型中无法观察到的症状特异性途径。结论:本研究强调了针对老年人抑郁症状和认知障碍的综合筛查和干预的临床和公共卫生价值。动机缺陷和精神状态缺陷可以作为可操作的跨诊断目标。未来的干预措施应针对具体症状,采取模块化措施,并具有文化敏感性。纵向神经生物学研究有必要阐明潜在的机制。
{"title":"The relationship between cognitive function and depressive symptoms in Chinese older adults: A cross-lagged panel network analysis","authors":"Shuaichen Li ,&nbsp;Jinglan Tan ,&nbsp;Yanwei Guo ,&nbsp;Junyao Li ,&nbsp;Renqin Hu ,&nbsp;Jiayi Ge ,&nbsp;Yiran Feng ,&nbsp;Wenjing Zhao ,&nbsp;Qinghua Luo","doi":"10.1016/j.genhosppsych.2025.10.016","DOIUrl":"10.1016/j.genhosppsych.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>The bidirectional association between depressive symptoms and cognitive decline has been extensively studied in Western populations, yet empirical evidence from non-Western contexts, particularly among Chinese older adults, remains limited. This study aimed to examine the longitudinal and symptom-level dynamics between depressive symptoms and cognitive functioning using a cross-lagged panel network (CLPN) approach.</div></div><div><h3>Methods</h3><div>Data were drawn from two waves (2015, 2018) of the China Health and Retirement Longitudinal Study (CHARLS), including 6824 individuals aged 50 years and above. Cognitive performance was assessed via the China Mini-Mental State Examination (CMMSE), and depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression Scale (CESD-8). A CLPN model was estimated to identify temporally predictive pathways and symptom-level interactions, with LASSO regularization ensuring model sparsity. Model stability was evaluated through nonparametric bootstrapping.</div></div><div><h3>Results</h3><div>Findings revealed a reciprocal, predominantly negative relationship between cognitive decline and depressive symptoms over time. “Mental State” (orientation, processing, and visuospatial skills) emerged as the central network hub and primary bridge from cognition to depression, while lack of motivation (“ I felt everything was an effort”) was the pivotal bridge symptom from depression to cognition. Specifically, “I felt everything was an effort” predicted subsequent declines in memory function, whereas better mental state predicted reduced depressive symptoms, including feeling depressed, trouble concentrating, and restless sleep. The network model highlighted symptom-specific pathways not observable in traditional latent variable models.</div></div><div><h3>Conclusions</h3><div>This study underscores the clinical and public health value of integrated screening and interventions targeting both depressive symptoms and cognitive impairment in older adults. Motivational deficits and mental state deficits may serve as actionable transdiagnostic targets. Future interventions should be symptom-specific, modular, and culturally sensitive. Longitudinal neurobiological studies are warranted to elucidate underlying mechanisms.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"97 ","pages":"Pages 203-208"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psilocybin-assisted psychotherapy for depression and anxiety associated with life threatening illness: A phase 2b randomized controlled trial 裸盖菇碱辅助心理治疗与生命威胁疾病相关的抑郁和焦虑:一项2b期随机对照试验
IF 3.7 2区 医学 Q1 PSYCHIATRY Pub Date : 2025-09-01 Epub Date: 2025-08-12 DOI: 10.1016/j.genhosppsych.2025.08.001
Margaret L. Ross , Ravi Iyer , Martin L. Williams , Mark Boughey , Clare O'Callaghan , Richard Hiscock , Justin Dwyer
<div><h3>Importance</h3><div>Psilocybin-assisted psychotherapy may offer a novel approach to treating depression, anxiety, and existential distress in individuals with life threatening illnesses, where current treatments show limited efficacy.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety of psilocybin-assisted psychotherapy versus active placebo and psychotherapy in adults with life-threatening illnesses.</div></div><div><h3>Design</h3><div>Double-blind, randomized controlled phase 2b trial (RCT) with an open-label extension and 6-month follow-up (January 2020 – October 2023).</div></div><div><h3>Setting</h3><div>Single-site study at a tertiary hospital's palliative care department (St. Vincent's Hospital Melbourne affiliated with the University of Melbourne).</div></div><div><h3>Participants</h3><div>Adults aged 18–80 with a life-threatening illness and clinically significant depression and/or anxiety.</div></div><div><h3>Interventions</h3><div>Participants were randomized to receive 25 mg psilocybin or 100 mg niacin (active placebo), alongside three preparatory psychotherapy and six post-dose integration psychotherapy sessions. After 6–7 weeks post double blind dose, all participants received 25 mg psilocybin in an open-label extension, enabling a two dose versus one dose group comparator. Participants were followed up to 26 weeks post open label dose.</div></div><div><h3>Main outcomes and measures</h3><div>Primary outcome was change in depression and anxiety symptoms, assessed using the Hospital Anxiety and Depression Scale (HADS), from baseline to 6–7 weeks post-dose. Key secondary outcomes included the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory – State version (STAI-S), which provided complementary, dimensional measures of depression and anxiety over the same time period.</div><div>Additional secondary outcomes included Death Attitudes Profile, WHOQOL-BREF, State-Trait Anxiety Inventory (STAI-Trait scale), Mystical Experiences Questionnaire, and Persisting Effects Questionnaire. Exploratory outcomes included spiritual well-being, hopelessness, demoralization, and HADS-Trait scores.</div></div><div><h3>Results</h3><div>Thirty-five participants (mean age 56.0; 54.3 % female) were randomized (psilocybin: n = 17; placebo: n = 18). At 6–7 weeks, psilocybin produced significantly greater reductions in HADS depression (B = –2.49; P = .02; d = 1.12), BDI-II (B = –7.56; P = .004; d = 2.97), and STAI-State anxiety (B = –12.59; P = .005; d = 4.51) compared to placebo. Benefits were sustained at 26 weeks. Exploratory outcomes demonstrated enhanced spiritual well-being, quality of life, and significant reductions in demoralization, death anxiety and hopelessness. No serious treatment-emergent adverse events occurred. Psilocybin was associated with more mild-to-moderate adverse events. One participant withdrew due to anxiety during dosing.</div></div><div><h3>Conclusions and relevance</h3><div
重要性裸盖菇碱辅助心理治疗可能提供一种治疗抑郁症、焦虑症和存在性痛苦的新方法,这些患者患有危及生命的疾病,目前的治疗方法疗效有限。目的评价裸盖菇素辅助心理治疗对成人危重疾病患者的疗效和安全性。设计双盲,随机对照2b期试验(RCT),开放标签延长和6个月随访(2020年1月至2023年10月)。在一家三级医院的姑息治疗部门(墨尔本大学附属的墨尔本圣文森特医院)进行的单点研究。参与者年龄在18-80岁之间,患有危及生命的疾病和临床显著的抑郁和/或焦虑。干预措施:参与者随机接受25毫克裸盖菇素或100毫克烟酸(有效安慰剂),同时接受3次预备心理治疗和6次剂量后整合心理治疗。在双盲给药6-7周后,所有参与者在开放标签扩展中接受25mg裸盖菇素,实现双剂量组与单剂量组的比较。参与者在开放标签剂量后随访至26周。主要结局和测量方法主要结局是抑郁和焦虑症状的变化,使用医院焦虑和抑郁量表(HADS)评估,从基线到给药后6-7周。主要的次要结果包括贝克抑郁量表- ii (BDI-II)和状态-特质焦虑量表-状态版本(STAI-S),它们提供了在同一时间段内抑郁和焦虑的补充维度测量。其他次要结果包括死亡态度、WHOQOL-BREF、状态-特质焦虑量表(STAI-Trait量表)、神秘体验问卷和持续效应问卷。探索性结果包括精神健康、绝望、士气低落和HADS-Trait得分。结果35名参与者(平均年龄56.0岁,54.3%为女性)被随机分配(裸盖菇素:n = 17;安慰剂:n = 18)。在6-7周时,与安慰剂相比,裸盖菇素显著降低了HADS抑郁(B = -2.49; P = 0.02; d = 1.12)、BDI-II (B = -7.56; P = 0.004; d = 2.97)和抑郁状态焦虑(B = -12.59; P = 0.005; d = 4.51)。益处持续到26周。探索性结果表明,精神健康、生活质量得到提高,士气低落、死亡焦虑和绝望情绪显著减少。未发生严重的治疗不良事件。裸盖菇素与更多的轻中度不良事件相关。一名参与者在给药期间因焦虑而退出。结论及相关性:裸盖菇碱辅助心理治疗似乎是安全的,并且可以持久地缓解患有危及生命疾病的个体的抑郁和焦虑。
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General hospital psychiatry
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