General Psychiatry最新文献

Background: The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation (iTBS) and hinders the identification of predictive factors. This study investigated functional network connectivity and predictors of iTBS treatment outcomes in adolescents and young adults with depression.

Aim: This study aimed to identify default mode network (DMN)-based connectivity patterns associated with varying iTBS treatment outcomes in depression.

Methods: Data from a randomised controlled trial of iTBS in depression (n=82) were analysed using a data-driven approach to classify homogeneous subgroups based on the DMN. Connectivity subgroups were compared on depressive symptoms and cognitive function at pretreatment and post-treatment. Furthermore, the predictive significance of baseline inflammatory cytokines on post-treatment outcomes was evaluated.

Results: Two distinct subgroups were identified. Subgroup 1 exhibited high heterogeneity and greater centrality in the posterior cingulate cortex and retrosplenial cortex, while subgroup 2 showed more homogeneous connectivity patterns and greater centrality in the temporoparietal junction and posterior inferior parietal lobule. No main effect for subgroup, treatment or subgroup×treatment interaction was revealed in the improvement of depressive symptoms. A significant subgroup×treatment interaction related to symbol coding improvement was detected (F=5.22, p=0.026). Within subgroup 1, the active group showed significantly greater improvement in symbol coding compared with the sham group (t=2.30, p=0.028), while baseline levels of interleukin-6 and C-reactive protein emerged as significant indicators for predicting improvements in symbolic coding (R²=0.35, RMSE (root-mean-square error)=5.72, p=0.013). Subgroup 2 showed no significant findings in terms of cognitive improvement or inflammatory cytokines predictions.

Conclusions: Data-driven network analyses offer valuable insights into iTBS treatment outcomes in depression, providing clues for predicting cognitive improvements from an inflammatory perspective.

Trial registration number: ChiCTR2100042346.

Background: Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims: This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods: This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results: A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion: This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Background: Schizophrenia is characterised by pervasive cognitive deficits that significantly impair daily functioning and quality of life. Pharmacological treatments have limited efficacy in addressing these deficits, highlighting the need for adjunctive interventions like computerised cognitive training (CCT).

Aims: This study aimed to evaluate the effects of a 30-session CCT programme on mental well-being and cognitive performance in individuals with schizophrenia. Additionally, it assessed the usability and acceptability of CCT in this population.

Methods: A double-blind, randomised clinical trial was conducted with 54 participants assigned to intervention and control groups. Cognitive and mental health outcomes were assessed using validated tools such as the Depression Anxiety Stress Scale 21, the Warwick-Edinburgh Mental Wellbeing Scale and the Cambridge Neuropsychological Test Automated Battery. Usability was measured with the System Usability Scale (SUS). Assessments were conducted at baseline, post-intervention and 3 months post-follow-up.

Results: The CCT intervention significantly improved mental well-being, reduced stress and enhanced working memory (paired associate learning, spatial working memory and spatial span) compared with controls. However, no significant effects were observed for anxiety, depression or executive function. Usability scores were high (SUS=83.51), and compliance rates were strong (92.7%), indicating favourable participant engagement.

Conclusion: CCT demonstrated potential as an adjunctive treatment for schizophrenia, with significant improvements in targeted cognitive and mental health domains. The high usability and compliance rates support its feasibility for broader implementation. Further research is needed to optimise protocols and explore long-term benefits. CCT offers a promising approach to addressing mental health and cognitive challenges in schizophrenia, particularly for stress and working memory. Its usability and acceptability suggest it could be seamlessly integrated into clinical practice.

Background: Non-suicidal self-injury (NSSI) is a significant health concern among adolescents and young adults, often resulting from adverse childhood experiences (ACEs). Dissociation, post-traumatic symptoms and attachment style may have a role in shaping such associations.

Aims: This study aims to provide a unified model of the impact of ACEs on NSSI, exploring complex post-traumatic stress disorder (cPTSD) symptoms and dissociation as potential mediators and the role of the predominant attachment style in affecting such associations.

Methods: 1010 young individuals attending the last year of high school participated in this cross-sectional study. ACEs, cPTSD, dissociation and NSSI were evaluated using self-report questionnaires. We fitted a path model of NSSI, with ACEs as exogenous variables and cPTSD and dissociation as sequential mediators. Secure, fearful and preoccupied attachment styles were modelled as grouping variables.

Results: Our findings showed that dissociation mediated the impact of ACEs on NSSI in subjects with a fearful attachment style, as opposed to those with a preoccupied attachment for whom cPTSD symptoms mediated the ACEs-NSSI association.

Conclusions: Attachment styles moderate the relationship between ACEs and NSSI, with either dissociation or post-traumatic symptomatology mediating the impact of ACEs on NSSI, depending on the predominant attachment style. Our results highlight the importance of attachment as a pathway modifier in the relationships between different psychopathology dimensions, providing a useful framework to better conceptualise the ACEs-NSSI association.

Background: The patient-reported Dimensional Anhedonia Rating Scale (DARS) has been adapted into Chinese, so there is a need to evaluate its measurement properties in a Chinese population.

Aims: To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder (MDD) and its treatment sensitivity in a prospective clinical study.

Methods: Data were from a multicentre, prospective clinical study (NCT03294525), which recruited both patients with MDD, who were followed for 8 weeks, and healthy controls (HCs), assessed at baseline only. The analysis included confirmatory factor analysis, validity and sensitivity to change.

Results: Patients' mean (standard deviation (SD)) age was 34.8 (11.0) years, with 68.7% being female. 75.2% of patients with MDD had melancholic features, followed by 63.8% with anxious distress. Patients had experienced MDD for a mean (SD) of 9.2 (18) months. DARS scores covered the full range of severity with no major floor or ceiling effects. Confirmatory factor analysis showed adequate fit statistics (comparative fit index 0.976, goodness-of-fit index 0.935 and root mean square error of approximation 0.055). Convergent validity with anhedonia-related measures was confirmed. While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong (r=0.31, baseline), the DARS was found to differentiate between levels of depression. Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group (effect size 1.16) compared with the non-responder group (effect size 0.46).

Conclusions: This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD. Overall, the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment. The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.

Background: Postoperative delirium is one of the most common complications in the older surgical population, but its pathogenesis and biomarkers are largely undetermined. Retinal layer thickness has been demonstrated to be associated with cognitive function in mild cognitive impairment and patients with Alzheimer's disease. However, relatively little is known about possible retinal layer thickness among patients with postoperative delirium.

Aims: We aimed to investigate the relationship between retinal layer thickness and postoperative delirium in this cross-sectional study.

Methods: The participants (≥65 years old) having elective surgery under general anaesthesia were screened via medical records from Shanghai 10th People's Hospital. Preoperative macular thickness and peripapillary retinal nerve fibre layer (RNFL) thickness were measured using optical coherence tomography (OCT). The Confusion Assessment Method (CAM) algorithm and CAM-Severity (CAM-S) were used to assess the incidence and severity of postoperative delirium on the first, second and third days after surgery.

Results: Among 169 participants (mean (standard deviation (SD) 71.15 (4.36) years), 40 (24%) developed postoperative delirium. Notably, individuals who developed postoperative delirium exhibited thicker preoperative macular thickness in the right eye compared with those who did not (mean (SD) 283.35 (27.97) µm vs 273.84 (20.14) µm, p=0.013). Furthermore, the thicker preoperative macular thickness of the right eye was associated with a higher incidence of postoperative delirium (adjusted odds ratio 1.593, 95% confidence interval (CI) 1.093 to 2.322, p=0.015) and greater severity (adjusted mean difference (β)=0.256, 95% CI 0.037 to 0.476, p=0.022) after adjustment for age, sex and Mini-Mental State Examination (MMSE) scores. However, such a difference or association did not appear in the left macular or bilateral peripapillary RNFL thicknesses.

Conclusions: Current findings demonstrated that preoperative macular thickness might serve as a potential non-invasive marker for the vulnerability of developing postoperative delirium in older surgical patients. Further large-scale validation studies should be performed to confirm these results.