General Psychiatry最新文献

Abstract:

Background: There have been numerous intervention studies focusing on the development of preterm infants, but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants. The aspects and extent to which the home environment affects the early (18 months corrected age) neuropsychological development of preterm infants are still unclear.

Aims: This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit (NICU). It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.

Methods: In this retrospective cross-sectional study, 275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital. The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient (evaluated by the Gesell Developmental Scale) and the rate of developmental delays at 18 months corrected age.

Results: A total of 41.454% of the infants were extremely preterm. The developmental quotient scores at 18 months corrected age were in the middle of the scale. The language domain had the highest rate of developmental delay (46.182%), followed by the adaptive domain (37.091%). Multiple logistic regression analyses showed that compared with infants in supportive home environments, infants with moderate/unsupportive home environments had significantly elevated risks of development delay: 2.162-fold for global (odds ratio (OR) 2.162, 95% confidence interval (CI) 1.274 to 3.665, p=0.004), 2.193-fold for fine motor (OR 2.193, 95% CI 1.161 to 4.140, p=0.016), 2.249-fold for language (OR 2.249, 95% CI 1.336 to 3.786, p=0.002) and 2.042-fold for personal-social (OR 2.042, 95% CI 1.149 to 3.628, p=0.015).

Conclusions: A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants. It is associated with higher developmental quotient scores and protects against neuropsychiatric delays. Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.

Background: Globally, suicide is the third leading cause of death among girls aged 15-19 years. However, there is a growing concern that suicide research has paid little attention to pregnant adolescent girls, particularly in low-income and middle-income countries, including Ghana, where nearly one in seven adolescents experiences (unwanted) pregnancy.

Aims: To assess the prevalence and correlates of suicidal ideation and suicide attempt and the self-reported reasons for attempted suicide among pregnant adolescent girls in Ghana.

Methods: We collected cross-sectional data (between August 2022 and December 2023) using structured anonymous questionnaires from a sample of 449 pregnant adolescent girls (aged 14-19 years) drawn from the three geographical zones of Ghana. We applied bivariable and multivariable analysis techniques to the data.

Results: Overall, 28.51% (95% confidence interval (CI) 24.37% to 32.93%) reported suicidal ideation, and 18.04% (95% CI 14.59% to 21.91%) reported suicide attempt during the current pregnancy. Participants who reported attempted suicide endorsed more interpersonal reasons (eg, to communicate distress, to seek help or to influence others) than intrapersonal reasons for their attempted suicide. In the final adjusted logistic regression models, food insecurity (adjusted odds ratio (aOR)=2.69; 95% CI 1.34 to 5.41; p=0.005) was uniquely associated with increased odds of suicidal ideation. Adverse childhood experiences (aOR=3.04; 95% CI 1.33 to 6.97; p=0.008), history of attempted suicide before current pregnancy (aOR=3.47; 95% CI 1.27 to 9.47; p=0.0.015) and depression (measured by the 5-item World Health Organization Well-Being Index; aOR=0.31; 95% CI 0.12 to 0.77; p=0.012) were uniquely associated with increased odds of suicide attempt. Five variables were commonly associated with increased odds of both suicidal ideation and suicide attempt: conflict with parents, alcohol use, pregnancy-related anxiety, history of attempted suicide and intimate partner violence. While being in junior high school was uniquely associated with reduced odds of suicidal ideation, intimate partner's acceptance of paternity was commonly associated with reduced odds of both suicidal ideation and suicide attempt.

Conclusions: Although the prevalence estimates of suicidal ideation and suicide attempt in this study are comparable with known rates among non-pregnant adolescent girls in Ghana, additional research is needed to nuance our understanding of the correlates identified in this study. The evidence also highlights a need for both routine antepartum primary care mental health screening for suicidality and related risks and targeted prevention and intervention programmes.

Background: Non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), may offer an alternative treatment strategy for impulsive behaviour. By modulating brain activity, these techniques could potentially enhance impulse control and mitigate impulsivity.

Aims: To provide a comprehensive analysis of the correlation between NIBS parameters, targeted brain regions and impulsivity.

Methods: We systematically searched PubMed, Scopus and Embase on 5 April 2023 for randomised controlled trials (RCTs) of NIBS on impulsivity. Unbiased Hedges' g with 95% CIs was used to define the effect size. Cochran Q test and I² statistics were used to assess for heterogeneity; p values inferior to 0.10 and I²>25% were considered significant for heterogeneity. Publication bias was investigated by funnel plot analysis of point estimates according to study weights, by Egger's regression test and by non-parametric rank correlation (Begg) test.

Results: A total of 18 studies were included, comprising 655 patients from 14 RCTs and four randomised crossover studies. The meta-analysis of effect sizes from 9 tDCS studies on impulsivity did not show a significant effect (g=-0.18; 95% CI -0.46 to 0.10; p=0.210) and from 9 repetitive TMS (rTMS) studies also did not yield a statistically significant effect (g=0.21; 95% CI -0.38 to 0.80; p=0.490). When analysing active tDCS using Barratt Impulsiveness Scale version 11, the scores showed a trend towards improvement with active tDCS over placebo (g=-0.54; 95% CI -0.97 to -0.12; p<0.05; I²=0%).

Conclusions: There is currently insufficient evidence to support the clinical use of rTMS or tDCS as a means of reducing impulsivity in individuals with mental disorders. The main limitations of this study are the lack of available patient-level data, a limited number of studies, the lack of consensus on the structure of impulsivity and variability in how impulsivity is measured and conceptualised.

Prospero registration number: CRD42023413684.

Abstract:

Background: The knowledge about the prevalence of schizophrenia among people with intellectual disabilities (ID) is sparse, particularly concerning the distribution in different age groups.

Aims: To investigate the prevalence of diagnoses in the schizophrenia spectrum among people with ID compared with the general population (gPop).

Methods: This was an 8-year longitudinal register study. The participants were all residents of Skåne on 1 January 2014. People with a diagnosis of ID (F7 in International Statistical Classification of Diseases and Related Health Problems 10th Revision) or Down syndrome (DS; Q90), or service and support for people with ID/autism spectrum disorder (ASD) comprised the ID cohort (n=14 716). After excluding family members of people in the ID cohort, the remaining population of Skåne comprised the gPop cohort (n=1 226 955).The primary outcome measure was having at least one diagnosis in the schizophrenia spectrum (F20-F29). Secondary outcomes were single diagnoses within the schizophrenia spectrum.

Results: The prevalence of schizophrenia spectrum diagnoses was 7.2% in the ID cohort. This was more than an eightfold increase compared with the gPop (relative risk (RR) 8.45; 95% CI 7.94 to 9.00). The risk was also high among children (aged 0-18 years at the start of the study period; RR 9.42; 95% CI 7.36 to 12.05). In the subcohort comprising those with a diagnosis of DS, the risk of schizophrenia diagnosis was more than twice as high as in gPop. Concomitant ASD or genetic syndrome did not carry an excess risk among people with ID when compared with the gPop.

Conclusions: The findings of the present study support earlier assumptions that people with vulnerable brains develop psychotic disorders more frequently and that the onset age is lower than among people in the gPop. Habilitation services for children and adolescents, as well as general mental health services, should keep in mind that schizophrenia may be present when children and adolescents show severely decreased functioning, anxiety or aggressive behaviour.

This paper aims to present a Statistical Analysis Software (SAS) macro %BBIplus, offering estimation and visualisation methods for the Bang's Blinding Index (BBI) for randomised controlled trials (RCTs) with various designs. We developed the SAS macro programme %BBIplus to facilitate the implementation of BBI. This user-friendly programme allows for easy and rapid estimation and visualisation of BBI across different scenarios, including pairwise comparison RCTs with two arms, double-dummy design RCTs with three arms and factorial design RCTs with four arms. The programme requires no pre-existing data set, and users only need to input the number of individuals of correct, uncertain or wrong guesses in each intervention or control group. We illustrate the functionality of %BBIplus using blinding assessment data from three previously published RCTs: BBR (adjunctive berberine reduces antipsychotic-associated weight gain and metabolic syndrome in patients with schizophrenia: a randomised controlled trial), SELECT-TDCS (the sertraline versus electrical current therapy for treating depression clinical study: results from a factorial, randomised controlled trial) and ELECT-TDCS (trial of electrical direct-current therapy versus escitalopram for depression) studies. The programme estimates the BBI for each arm, providing point estimates, 95% CI and associated p values. Additionally, %BBIplus can visualise the estimations through forest plots and make the judgement for the success of blinding easily and rapidly. This tool caters to the needs of clinical trial investigators, offering a comprehensive solution for estimating and visualising the blinding index under various RCT designs.