General Psychiatry最新文献

Abstract:

Background: Evidence on the effects of different exercise interventions on cognitive function is insufficient.

Aims: To evaluate the feasibility and effects of remotely supervised aerobic exercise (AE) and resistance exercise (RE) interventions in older adults with mild cognitive impairment (MCI).

Methods: This study is a 6-month pilot three-arm randomised controlled trial. Eligible participants (n=108) were recruited and randomised to the AE group, RE group or control (CON) group with a 1:1:1 ratio. Interventions were delivered at home with remote supervision. We evaluated participants' global cognition, memory, executive function, attention, physical activity levels, physical performance and muscle strength of limbs at baseline, 3 months (T1) and 6 months (T2) after randomisation. A linear mixed-effects model was adopted for data analyses after controlling for covariates. Tukey's method was used for adjusting for multiple comparisons. Sensitivity analyses were performed after excluding individuals with low compliance rates.

Results: 15 (13.89%) participants dropped out. The median compliance rates in the AE group and RE group were 67.31% and 93.27%, respectively. After adjusting for covariates, the scores of the Alzheimer's Disease Assessment Scale-Cognitive subscale in the AE group decreased by 2.04 (95% confidence interval (CI) -3.41 to -0.67, t=-2.94, p=0.004) and 1.53 (95% CI -2.88 to -0.17, t=-2.22, p=0.028) points more than those in the CON group at T1 and T2, respectively. The effects of AE were still significant at T1 (estimate=-1.70, 95% CI -3.20 to -0.21, t=-2.69, p=0.021), but lost statistical significance at T2 after adjusting for multiple comparisons. As for executive function, the Stroop time interference in the RE group decreased by 11.76 s (95% CI -21.62 to -1.90, t=-2.81, p=0.015) more than that in the AE group at T2 after Tukey's adjustment. No other significant effects on cognitive functions were found.

Conclusions: Both remotely supervised AE and RE programmes are feasible in older adults with MCI. AE has positive effects on global cognition, and RE improves executive function.

Trial registration number: ChiCTR2100045582.

Background: As the population in China rapidly ages, the prevalence of mild cognitive impairment (MCI) is increasing considerably. However, the causes of MCI vary. The continued lack of understanding of the various subtypes of MCI impedes the implementation of effective measures to reduce the risk of advancing to more severe cognitive diseases.

Aims: To estimate the prevalence and incidence rates of two MCI subtypes-amnestic MCI (aMCI) and vascular cognitive impairment without dementia (VCIND)-and to determine modifiable factors for them among older individuals in a multiregional Chinese cohort.

Method: This 1-year longitudinal study surveyed a random sample of participants aged≥60 years from a large, community-dwelling cohort in China. Baseline lifestyle data were self-reported, while vascular and comorbid conditions were obtained from medical records and physical examinations. In total, 3514 and 2051 individuals completed the baseline and 1-year follow-up assessments, respectively. Logistic and linear regression analyses were used to identify the modifiable factors for MCI subtypes and predictors of cognitive decline, respectively.

Results: Among our participants, aMCI and VCIND demonstrated prevalence of 14.83% and 2.71%, respectively, and annual incidence (per 1000 person-years) of 69.6 and 10.6, respectively. The risk factor for aMCI was age, whereas its protective factors were high education level, tea consumption and physical activity. Moreover, VCIND risk factors were age, hypertension and depression. The presence of endocrine disease, cerebral trauma or hypertension was associated with a faster decline in cognition over 1 year.

Conclusions: MCI is a serious health problem in China that will only worsen as the population ages if no widespread interventions are implemented. Preventive strategies that promote brain activity and support healthy lifestyle choices are required. We identified modifiable factors for MCI in older individuals. The easy-to-adopt solutions such as tea consumption and physical activity can aid in preventing MCI.

Trial registration number: NCT03672448.

Background: Dynamic interpersonal therapy (DIT) is a short-term psychodynamic psychotherapy that has been shown to effectively reduce depressive symptoms in patients with major depressive disorder (MDD). In DIT, the depressive symptoms are formulated as responses to impaired mentalisation. DIT aims to alleviate depressive symptoms by improving mentalising.

Aims: This study aimed to examine the effect of DIT on improving mentalising and the mediating effect of mentalising in changes in depressive symptoms.

Methods: Outpatients received either DIT combined with antidepressant medication treatment (DIT group) or antidepressant medication treatment alone (ADM group) for 16 weeks. The Hamilton Depression Rating Scale (HAMD), Patient Health Questionnaire (PHQ) and Reflective Functioning Questionnaire (RFQ) were used. The intention-to-treat principle, mixed linear models, multiple imputation, Pearson's correlation analysis and mediation analysis were conducted. The per-protocol principle was used as sensitivity analysis.

Results: The DIT group had significantly lower HAMD (least-squares (LS) mean difference=-3.756, p<0.001), PHQ (LS mean difference=-4.188, p<0.001), uncertainty about mental states in the RFQ (RFQ-U, LS mean difference=-2.116, p<0.001) and higher certainty about mental states in the RFQ (RFQ-C, LS mean difference=2.214, p=0.028) scores than the ADM group at post-treatment. The change in RFQ-C was marginally significantly correlated with the change in HAMD (r=-0.218, p_corrected=0.09). The change in RFQ-U was significantly correlated with the change in HAMD (r=0.269, p_corrected=0.024) and the change in PHQ (r=0.343, p_corrected<0.001). When using RFQ-U as the mediating variable and PHQ as the dependent variable, a significant mediating effect was found (p=0.043, 95% confidence interval 0.024 to 1.453).

Conclusions: The DIT group yielded better outcomes compared with the ADM group in reducing depressive symptoms and improving mentalising. Improvements in mentalising were associated with reductions in depressive symptoms. These findings support that mentalising may contribute to the therapeutic effects of DIT in MDD.

Background: Social media listening is a new approach for gathering insights from social media platforms about users' experiences. This approach has not been applied to analyse discussions about Alzheimer's disease (AD) in China.

Aims: We aimed to leverage multisource Chinese data to gain deeper insights into the current state of the daily management of Chinese patients with AD and the burdens faced by their caregivers.

Methods: We searched nine mainstream public online platforms in China from September 2010 to March 2024. Natural language processing tools were used to identify patients and caregivers, and categorise patients by disease stage for further analysis. We analysed the current state of patient daily management, including diagnosis and treatment, choice of treatment scenarios, patient safety and caregiver concerns.

Results: A total of 1211 patients with AD (66% female, 82% aged 60-90) and 756 caregivers for patients with AD were identified from 107 556 online sources. Most patients were derived from online consultation platforms (43%), followed by bulletin board system platforms (24%). Among the patients categorised into specific disease stages (n=382), 42% were in the moderate stage. The most frequent diagnostic tools included medical history (97%) and symptoms (84%). Treatment options for patients with AD primarily included cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonists and antipsychotics. Both quantitative and qualitative analysis of patients who experienced wandering (n=92) indicated a higher incidence of wandering during the moderate stage of the disease. Most caregivers were family members, with their primary concerns focusing on disease management and treatment (90%), followed by daily life care (37%) and psychosocial support (25%).

Conclusions: Online platform data provide a broad spectrum of real-world insights into individuals affected by AD in China. This study enhances our understanding of the experiences of patients with AD and their caregivers, providing guidance for developing personalised interventions, providing advice for caregivers and improving care for patients with AD.

Background: Ongoing debates question the harm of internet use with the evolving technology, as many individuals transition from regular to problematic internet use (PIU). The habenula (Hb), located between the thalamus and the third ventricle, is implicated in various psychiatric disorders. In addition, personality features have been suggested to play a role in the pathophysiology of PIU.

Aims: This study aimed to investigate Hb volumetry in individuals with subclinical PIU and the mediating effect of personality traits on this relationship.

Methods: 110 healthy adults in this cross-sectional study underwent structural magnetic resonance imaging. Hb segmentation was performed using a deep learning technique. The Internet Addiction Test (IAT) and the NEO Five-Factor Inventory were used to assess the PIU level and personality, respectively. Partial Spearman's correlation analyses were performed to explore the relationships between Hb volumetry, IAT and NEO. Multiple regression analysis was applied to identify personality traits that predict IAT scores. The significant trait was then treated as a mediator between Hb volume and IAT correlation in mediation analysis with a bootstrap value of 5000.

Results: Relative Hb volume was negatively correlated with IAT scores (partial rho=-0.142, p=0.009). The IAT score was positively correlated with neuroticism (partial rho=0.430, p<0.001) and negatively correlated with extraversion, agreeableness and conscientiousness (partial rho=-0.213, p<0.001; partial rho=-0.279, p<0.001; and partial rho=-0.327, p<0.001). There was a significant indirect effect of Hb volume on this model (β=-0.061, p=0.048, boot 95% confidence interval: -0.149 to -0.001).

Conclusions: This study uncovered a crucial link between reduced Hb volume and heightened PIU. Our findings highlight neuroticism as a key risk factor for developing PIU. Moreover, neuroticism was shown to mediate the relationship between Hb volume and PIU tendency, offering valuable insight into the complexities of this interaction.