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Brain-wide activation involved in 15 mA transcranial alternating current stimulation in patients with first-episode major depressive disorder 15 毫安经颅交变电流刺激对首发重度抑郁症患者的全脑激活作用
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-03-01 DOI: 10.1136/gpsych-2023-101338
Jie Wang, Wenfeng Zhao, Huang Wang, Haixia Leng, Qing Xue, Mao Peng, Baoquan Min, Xiukun Jin, Liucen Tan, Keming Gao, Hongxing Wang
Background Although 15 mA transcranial alternating current stimulation (tACS) has a therapeutic effect on depression, the activations of brain structures in humans accounting for this tACS configuration remain largely unknown. Aims To investigate which intracranial brain structures are engaged in the tACS at 77.5 Hz and 15 mA, delivered via the forehead and the mastoid electrodes in the human brain. Methods Actual human head models were built using the magnetic resonance imagings of eight outpatient volunteers with drug-naïve, first-episode major depressive disorder and then used to perform the electric field distributions with SimNIBS software. Results The electric field distributions of the sagittal, coronal and axial planes showed that the bilateral frontal lobes, bilateral temporal lobes, hippocampus, cingulate, hypothalamus, thalamus, amygdala, cerebellum and brainstem were visibly stimulated by the 15 mA tACS procedure. Conclusions Brain-wide activation, including the cortex, subcortical structures, cerebellum and brainstem, is involved in the 15 mA tACS intervention for first-episode major depressive disorder. Our results indicate that the simultaneous involvement of multiple brain regions is a possible mechanism for its effectiveness in reducing depressive symptoms. Data are available upon reasonable request.
背景 虽然 15 毫安经颅交变电流刺激(tACS)对抑郁症有治疗效果,但这种 tACS 配置对人脑结构的激活作用在很大程度上仍不清楚。目的 研究通过前额和乳突电极在人脑中以 77.5 Hz 和 15 mA 的频率发出的 tACS 会激活哪些颅内大脑结构。方法 利用八名门诊志愿者的磁共振图像建立了实际的人类头部模型,这些志愿者均患有初次发作的重度抑郁症,未接受过药物治疗,然后利用 SimNIBS 软件进行电场分布分析。结果 矢状面、冠状面和轴面的电场分布显示,双侧额叶、双侧颞叶、海马、扣带回、下丘脑、丘脑、杏仁核、小脑和脑干受到 15 mA tACS 程序的明显刺激。结论 15 mA tACS 对首发重度抑郁障碍的干预涉及整个大脑的激活,包括皮层、皮层下结构、小脑和脑干。我们的研究结果表明,多个脑区同时参与是该疗法有效减轻抑郁症状的可能机制。如有合理要求,可提供相关数据。
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引用次数: 0
J-shaped association between dietary thiamine intake and the risk of cognitive decline in cognitively healthy, older Chinese individuals. 膳食硫胺素摄入量与认知能力健康的中国老年人认知能力下降风险之间的 "J "形关系。
IF 5.3 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-20 eCollection Date: 2024-01-01 DOI: 10.1136/gpsych-2023-101311
Chengzhang Liu, Qiguo Meng, Yuanxiu Wei, Xinyue Su, Yuanyuan Zhang, Panpan He, Chun Zhou, Mengyi Liu, Ziliang Ye, Xianhui Qin

Background: The prospective association of dietary thiamine intake with the risk of cognitive decline among the general older adults remains uncertain.

Aims: To investigate the association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals.

Methods: The study included a total of 3106 participants capable of completing repeated cognitive function tests. Dietary nutrient intake information was collected through 3-day dietary recalls and using a 3-day food-weighed method to assess cooking oil and condiment consumption. Cognitive decline was defined as the 5-year decline rate in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified.

Results: The median follow-up duration was 5.9 years. There was a J-shaped relationship between dietary thiamine intake and the 5-year decline rate in global and composite cognitive scores, with an inflection point of 0.68 mg/day (95% confidence interval (CI): 0.56 to 0.80) and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake. Before the inflection point, thiamine intake was not significantly associated with cognitive decline. Beyond the inflection point, each unit increase in thiamine intake (mg/day) was associated with a significant decrease of 4.24 (95% CI: 2.22 to 6.27) points in the global score and 0.49 (95% CI: 0.23 to 0.76) standard units in the composite score within 5 years. A stronger positive association between thiamine intake and cognitive decline was observed in those with hypertension, obesity and those who were non-smokers (all p<0.05).

Conclusions: This study revealed a J-shaped association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals, with an inflection point at 0.68 mg/day and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake.

背景:目的:研究认知健康的中国老年人膳食中硫胺素摄入量与认知能力下降之间的关系:研究共纳入了3106名能够完成重复认知功能测试的参与者。膳食营养素摄入量信息通过3天膳食回顾和3天食物称重法收集,以评估食用油和调味品的摄入量。认知能力下降的定义是根据认知状况电话访谈的子集项目得出的总体或综合认知得分的5年下降率:中位随访时间为 5.9 年。膳食中硫胺素的摄入量与5年期总体和综合认知评分的下降率呈 "J "形关系,拐点为0.68毫克/天(95%置信区间(CI):0.56至0.80),膳食中硫胺素的摄入量为0.60-1.00毫克/天时风险最小。在拐点之前,硫胺素摄入量与认知能力下降无明显关联。超过拐点后,硫胺素摄入量每增加一个单位(毫克/天),5年内的总分就会显著下降4.24(95% CI:2.22至6.27)分,综合得分显著下降0.49(95% CI:0.23至0.76)个标准单位。在高血压、肥胖和不吸烟的人群中,硫胺素摄入量与认知能力下降之间的正相关性更强(均为 p 结论:这项研究显示,在认知能力健康的中国老年人中,膳食硫胺素摄入量与认知能力下降之间呈 "J "形关联,拐点在0.68毫克/天,而膳食硫胺素摄入量在0.60-1.00毫克/天时风险最小。
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引用次数: 0
Gut microbiota-derived short-chain fatty acids and depression: deep insight into biological mechanisms and potential applications 肠道微生物群衍生的短链脂肪酸与抑郁症:深入了解生物机制和潜在应用
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101374
Junzhe Cheng, Hongkun Hu, Yumeng Ju, Jin Liu, Mi Wang, Bangshan Liu, Yan Zhang
The gut microbiota is a complex and dynamic ecosystem known as the ‘second brain’. Composing the microbiota-gut-brain axis, the gut microbiota and its metabolites regulate the central nervous system through neural, endocrine and immune pathways to ensure the normal functioning of the organism, tuning individuals’ health and disease status. Short-chain fatty acids (SCFAs), the main bioactive metabolites of the gut microbiota, are involved in several neuropsychiatric disorders, including depression. SCFAs have essential effects on each component of the microbiota-gut-brain axis in depression. In the present review, the roles of major SCFAs (acetate, propionate and butyrate) in the pathophysiology of depression are summarised with respect to chronic cerebral hypoperfusion, neuroinflammation, host epigenome and neuroendocrine alterations. Concluding remarks on the biological mechanisms related to gut microbiota will hopefully address the clinical value of microbiota-related treatments for depression.
肠道微生物群是一个复杂而动态的生态系统,被称为 "第二大脑"。肠道微生物群及其代谢产物构成了微生物群-肠道-大脑轴,通过神经、内分泌和免疫途径调节中枢神经系统,确保机体的正常功能,调整个体的健康和疾病状态。短链脂肪酸(SCFAs)是肠道微生物群的主要生物活性代谢产物,与包括抑郁症在内的多种神经精神疾病有关。在抑郁症中,SCFAs 对微生物群-肠道-大脑轴的每个组成部分都有重要影响。本综述总结了主要 SCFAs(醋酸酯、丙酸酯和丁酸酯)在抑郁症病理生理学中的作用,涉及慢性脑灌注不足、神经炎症、宿主表观基因组和神经内分泌改变。最后,对与肠道微生物群相关的生物机制进行了总结,希望能探讨与微生物群相关的抑郁症治疗方法的临床价值。
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引用次数: 0
Global, regional and national burdens of bipolar disorders in adolescents and young adults: a trend analysis from 1990 to 2019 全球、地区和国家青少年双相情感障碍负担:1990 年至 2019 年趋势分析
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101255
Yunxi Zhong, Yifan Chen, Xiaoying Su, Meiqi Wang, Qixiu Li, Ziming Shao, Long Sun
Background Bipolar disorder is identified as a cause of severe damage to the physical, psychological and social functioning of adolescents and young adults. Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10–24 years at global, regional and national levels from 1990 to 2019. Methods The data analysed in this study were from the Global Burden of Diseases 2019. The numbers, rates per 100 000 population, average annual percentage changes (AAPCs) of incidence, prevalence and years lived with disability (YLDs) of bipolar disorder are reported at the global, regional and national levels among individuals aged 10–24 years. Global trends by age, sex and Social Development Index (SDI) were further analysed. Results Globally, the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100 000 population (95% uncertainty interval (UI): 58.13 to 105.15) in 1990 to 84.97 per 100 000 population (95% UI: 61.73 to 113.46) in 2019, AAPC 0.24 (95% confidence interval (CI): 0.22 to 0.26). In the past three decades, there has been an increase in incidence, prevalence and YLDs in both males and females. The largest increase in incidence between 1990 and 2019 was observed in those aged 20–24 years old (from 51.76 per 100 000 population (95% UI: 26.81 to 87.20) in 1990 to 58.37 per 100 000 population (95% UI: 30.39 to 98.55) in 2019; AAPC 0.42 (95% CI: 0.38 to 0.47)). By the SDI quintile, the largest increase in incidence was observed in the middle SDI; however, the high SDI countries had the highest incidence. Regionally, the largest increase in incidence was observed in southern Latin America. At the national level, the most pronounced increase in the incidence was in Greenland. Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised. Data are available in a public, open access repository. Data in this article were collected from the Global Health Data Exchange ().
背景 双相情感障碍被认为是对青少年和年轻成年人的身体、心理和社会功能造成严重损害的一个原因。目的 本研究旨在确定从 1990 年到 2019 年全球、地区和国家层面 10-24 岁人群中躁狂症负担的变化趋势。方法 本研究分析的数据来自《2019 年全球疾病负担》。报告了全球、地区和国家层面 10-24 岁人群中躁狂症的发病率、患病率和残疾生活年数(YLDs)的数量、每 10 万人口的比率、年均百分比变化(AAPCs)。还进一步分析了按年龄、性别和社会发展指数(SDI)划分的全球趋势。结果 在全球范围内,青少年躁郁症的发病率从 1990 年的每 10 万人 79.21 例(95% 置信区间:58.13 至 105.15)上升到 2019 年的每 10 万人 84.97 例(95% 置信区间:61.73 至 113.46),AAPC 为 0.24(95% 置信区间:0.22 至 0.26)。在过去的三十年中,男性和女性的发病率、流行率和 YLD 均有所上升。1990 年至 2019 年间,20-24 岁人群的发病率增幅最大(从 1990 年的每 10 万人 51.76 例(95% UI:26.81 至 87.20)增至 2019 年的每 10 万人 58.37 例(95% UI:30.39 至 98.55);AAPC 为 0.42(95% CI:0.38 至 0.47))。从 SDI 五分位数来看,中等 SDI 国家的发病率增幅最大;然而,高 SDI 国家的发病率最高。从地区来看,拉丁美洲南部的发病率增幅最大。在国家层面,格陵兰岛的发病率增长最为明显。结论 1990 年至 2019 年间全球青少年发病率的上升表明,改善青少年心理健康的战略仍需得到重视。数据可在公开、开放的资料库中获取。本文中的数据收集自全球健康数据交换中心(Global Health Data Exchange)。
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引用次数: 0
Suicide, self-injury and violence 自杀、自伤和暴力
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101387
Kexin Zhang, Ziyang Wang, Xin Yu
To the editor: Non-suicidal self-injury (NSSI) is defined as direct, repetitive self-injury to bodily tissues without suicidal intent.1 The estimated prevalence of NSSI among adolescents is 17.2% worldwide2 with a comparable rate observed in China.3 As a behavioural addiction,4 NSSI poses a significant suicide risk,5 and is emerging as a major mental health problem among adolescents. To unravel this puzzle, the four-function model (FFM) distinguishes between interpersonal and intrapersonal functions, as well as positive and negative reinforcement functions,6 proving relatively comprehensive among various theoretical models. Despite its high prevalence rates and serious influences, adolescents and young adults with NSSI often seek information and social support online rather than offline from doctors or other professionals. One-third of young people with a history of self-injury report online help-seeking for self-injury.7 As of June 2023, China has a huge adolescent internet user base of close to 150 million.8 However, a limited number of studies have explored NSSI and online information-seeking and help-seeking in the Chinese context. Social media sites have raised concerns due to the presence of NSSI-related content.9 10 As one of the most commonly used social media platforms among Chinese users, Sina Weibo (Weibo hereafter) has a large user base with a large amount of user-generated content. The content on Weibo is mostly the self-expression of users, with pictures and text as the main focus, and the text content is limited to 140 Chinese characters, fostering an open content ecosystem. This study investigates ambiguous NSSI-related terms on Weibo. To our knowledge, this is the first published study to explore NSSI-related terms on a Chinese-language social network. The purposes of the current study are (1) to explore the meaning and consistency of ambiguous language use; (2) to explore the general social opinions towards NSSI …
致编辑:非自杀性自伤(NSSI)的定义是在没有自杀意图的情况下直接、重复地自伤身体组织。1 据估计,非自杀性自伤在全球青少年中的流行率为 17.2%,2 中国的流行率也与之相当。3 作为一种行为成瘾,4 非自杀性自伤有很大的自杀风险,5 并且正在成为青少年中的一个主要心理健康问题。为了揭开这一谜团,四项功能模型(FFM)区分了人际功能和人内功能,以及正强化功能和负强化功能,6 在各种理论模型中被证明是相对全面的。尽管 NSSI 的流行率很高,影响也很严重,但患有 NSSI 的青少年通常会在网上而不是线下向医生或其他专业人士寻求信息和社会支持。7 截至 2023 年 6 月,中国拥有近 1.5 亿庞大的青少年网民群体。8 然而,针对 NSSI 以及在中国背景下的网络信息寻求和帮助的研究数量有限。9 10 作为中国用户最常用的社交媒体平台之一,新浪微博(以下简称 "微博")拥有庞大的用户群和大量由用户生成的内容。微博上的内容大多是用户的自我表达,以图片和文字为主,文字内容限制在 140 个汉字以内,形成了一个开放的内容生态系统。本研究调查了微博上与 NSSI 相关的模糊词汇。据我们所知,这是第一项在中文社交网络上探讨 NSSI 相关术语的公开研究。本研究的目的是:(1)探讨模糊语言使用的意义和一致性;(2)探讨社会对 NSSI 的普遍看法 ...
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引用次数: 0
Comparisons of transcranial alternating current stimulation and repetitive transcranial magnetic stimulation treatment therapy for insomnia: a pilot study 经颅交变电流刺激和重复经颅磁刺激治疗失眠的比较:一项试点研究
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101184
Ziqiang Shao, Yongjian Guo, Lirong Yue, Xiaoyang Liu, Jiayi Liu, Xumeng Zhao, Xiaona Sheng, Dahua Yu, Yifei Zhu, Kai Yuan
To the editor: Insomnia disorder has a serious and widespread detrimental effect on humans with comorbidity with other mental or physical health problems.1 2 In recent years, non-invasive brain stimulation (NIBS) techniques, especially transcranial magnetic stimulation (TMS) and transcranial electrical stimulation, have been increasingly used for the treatment of brain diseases, including insomnia disorder. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proven to reduce neuronal excitability to modulate the abnormal hyperarousal of patients with insomnia. The efficacy of rTMS for insomnia has been observed, and rTMS may be a safe and effective option for insomnia treatment.3 However, the stimulation effects of rTMS have varied substantially across studies and individuals. rTMS was found to produce region-specific effects that critically depend on the connectivity profile of target regions, and an extended, trans-scale model has been developed.4 Unfortunately, it could not simply generalise across different protocols, which hindered the development of more precise and effective regulation for brain abnormalities. A previous review indicated that dorsolateral prefrontal cortex (DLPFC) stimulation by rTMS could modulate the release of key neurotransmitters in the sleep–awake cycle. Even though the proposed mechanisms were still speculative, the review indicated that the stimulation of DLPFC (right, left and bilaterally) with low frequencies (1 Hz) could improve sleep architecture and quality.5 Continued research into better rTMS protocols for treating insomnia disorder and further study of the mechanisms of efficacy were still warranted. It is also worth noting that transcranial alternating current stimulation (tACS) has received much attention in recent years. tACS was able to modulate neural oscillations of specific frequencies through entrainment.6 Such frequency specificity facilitated the precise modulation of the brain, leading to a better therapeutic effect. Currently, tACS has been showing results for initial sleep regulation and insomnia treatment.7 8 Since the role …
致编辑:失眠症对人类具有严重而广泛的危害,并与其他精神或身体健康问题合并存在。1 2 近年来,非侵入性脑刺激(NIBS)技术,尤其是经颅磁刺激(TMS)和经颅电刺激,越来越多地被用于治疗包括失眠症在内的脑部疾病。低频重复经颅磁刺激(rTMS)已被证实可以降低神经元的兴奋性,从而调节失眠患者的异常亢奋。经颅磁刺激对失眠症的疗效已被观察到,经颅磁刺激可能是治疗失眠症的一种安全有效的选择。3 然而,经颅磁刺激的刺激效果在不同研究和不同个体之间存在很大差异。经颅磁刺激产生的区域特异性效果主要取决于目标区域的连通性特征,并已开发出一个扩展的跨尺度模型。4 遗憾的是,该模型不能简单地在不同方案之间通用,这阻碍了针对大脑异常开发更精确有效的调节方法。之前的一篇综述指出,经颅磁刺激背外侧前额叶皮层(DLPFC)可以调节睡眠-觉醒周期中关键神经递质的释放。尽管提出的机制仍是推测性的,但该综述指出,用低频(1 赫兹)刺激 DLPFC(右侧、左侧和双侧)可改善睡眠结构和质量。5 目前仍需继续研究治疗失眠症的更好经颅磁刺激方案,并进一步研究其疗效机制。值得注意的是,经颅交变电流刺激(tACS)近年来也备受关注。tACS 能够通过夹带调节特定频率的神经振荡6 。目前,tACS 在初始睡眠调节和失眠治疗方面已初见成效。
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引用次数: 0
Exploring the influences of education, intelligence and income on mental disorders 探讨教育、智力和收入对精神障碍的影响
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101080
Ancha Baranova, Hongbao Cao, Fuquan Zhang
Background Previous studies have shown that educational attainment (EA), intelligence and income are key factors associated with mental disorders. However, the direct effects of each factor on major mental disorders are unclear. Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders. Methods Using genome-wide association study summary datasets, we performed Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to assess potential associations between the 3 factors (EA, N=766 345; household income, N=392 422; intelligence, N=146 808) and 13 common mental disorders, with sample sizes ranging from 9907 to 807 553. Inverse-variance weighting was employed as the main method in the MR analysis. Results Our MR analysis showed that (1) higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa, obsessive-compulsive disorder (OCD), bipolar disorder (BD) and autism spectrum disorder (ASD); (2) higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD; (3) higher household income protected against 10 mental disorders but confers risk for anorexia nervosa. Our MVMR analysis showed that (1) higher EA was a direct protective factor for attention-deficit/hyperactivity disorder (ADHD) and insomnia but a direct risk factor for schizophrenia, BD and ASD; (2) higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder (MDD) and ASD; (3) higher income was a direct protective factor for seven mental disorders, including schizophrenia, BD, MDD, ASD, post-traumatic stress disorder, ADHD and anxiety disorder. Conclusions Our study reveals that education, intelligence and income intertwine with each other. For each factor, its independent effects on mental disorders present a more complex picture than its overall effects. No data are available.
背景 以往的研究表明,教育程度(EA)、智力和收入是与精神障碍相关的关键因素。然而,各因素对主要精神障碍的直接影响尚不明确。目的 我们旨在评估这三个社会心理因素对常见精神障碍的整体和独立因果效应。方法 我们利用全基因组关联研究汇总数据集,进行了孟德尔随机化(MR)和多变量 MR(MVMR)分析,以评估这三个因素(EA,766 345 人;家庭收入,392 422 人;智力,146 808 人)与 13 种常见精神障碍之间的潜在关联,样本量从 9907 个到 807 553 个不等。MR 分析主要采用反方差加权法。结果 我们的磁共振分析表明:(1) 较高的 EA 是 8 种精神障碍的保护因素,但会导致神经性厌食症、强迫症、双相情感障碍和自闭症谱系障碍;(2) 较高的智力是 5 种精神障碍的保护因素,但会成为强迫症和自闭症谱系障碍的风险因素;(3) 较高的家庭收入可预防 10 种精神障碍,但会带来神经性厌食症的风险。我们的 MVMR 分析表明:(1) 较高的 EA 是注意力缺陷/多动障碍(ADHD)和失眠症的直接保护因素,但却是精神分裂症、BD 和 ASD 的直接风险因素;(2) 较高的智力是精神分裂症的直接保护因素,但却是重度抑郁障碍(MDD)和 ASD 的直接风险因素;(3) 较高的收入是精神分裂症、BD、MDD、ASD、创伤后应激障碍、ADHD 和焦虑症等七种精神障碍的直接保护因素。结论 我们的研究表明,教育、智力和收入相互交织。就每个因素而言,其对精神障碍的独立影响比其总体影响更复杂。暂无数据。
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引用次数: 0
Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive–behavioural therapy (CBT) intervention 孕期压力与产后抑郁和焦虑症状:认知行为疗法(CBT)干预的调节作用
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101136
Yunxiang Sun, Soim Park, Abid Malik, Najia Atif, Ahmed Zaidi, Atif Rahman, Pamela J Surkan
Background Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety. Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive–behavioural therapy (CBT) had a regulatory effect. Methods Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model. Results Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=−0.82, 95% CI: −1.46 to –0.18) and anxiety (B=−0.70, 95% CI: −1.25 to –0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes. Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences. Trial registration number [NCT03880032][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03880032&atom=%2Fgpsych%2F37%2F1%2Fe101136.atom
背景 人们对孕期压力(尤其是积极压力)与产后抑郁和焦虑之间的关系知之甚少。目的 我们调查了巴基斯坦有焦虑症状的低收入孕妇在怀孕不同阶段的积极和消极压力事件与产后心理健康结果之间的关系,并评估了基于认知行为疗法(CBT)的干预是否有调节作用。方法 参试者为 621 名患有轻度焦虑症的巴基斯坦孕妇。我们使用妊娠体验量表-简易版(Pregnancy Experience Scale-Brief Version)创建了六个分数来评估积极和消极的压力源。我们进行了多元线性回归,以检验在基线期和怀孕三个月时测量的这六项得分是否与产后焦虑和抑郁症状相关。通过在回归模型中加入交互项,考察了干预措施对这种关系的影响。结果 怀孕三个月时的烦恼频率与抑郁(B=0.22,95% 置信区间(CI):0.09 至 0.36)和焦虑(B=0.19,95% 置信区间(CI):0.08 至 0.30)呈正相关。在同一时间点,振奋强度与抑郁症状(B=-0.82,95% CI:-1.46 至 -0.18)和焦虑症状(B=-0.70,95% CI:-1.25 至 -0.15)呈负相关,而烦恼强度与抑郁症状(B=1.02,95% CI:0.36 至 1.67)和焦虑症状(B=0.90,95% CI:0.34 至 1.47)呈正相关。妊娠三个月中报告的烦恼与振奋的强度比与抑郁(B=1.40,95% CI:0.59 至 2.20)和焦虑(B=1.26,95% CI:0.57 至 1.96)呈正相关。干预加强了 "振奋 "的总体积极影响和 "烦恼 "的消极影响。孕早期至孕中期的基线孕期经历与心理健康结果无关。结论 怀孕三个月内的压力与产后焦虑和抑郁症状有关,而怀孕早期的压力与产后焦虑和抑郁症状无关。CBT 干预改变了孕期压力与产后心理健康结果之间的关联。尤其是在妊娠晚期,促进积极体验和减少消极体验的计划可能会减轻产后心理健康后果。试验注册号[NCT03880032][1]。如有合理要求,可提供相关数据。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03880032&atom=%2Fgpsych%2F37%2F1%2Fe101136.atom
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引用次数: 0
Methodological considerations of priming repetitive transcranial magnetic stimulation protocols in clinical populations 在临床人群中启动重复经颅磁刺激方案的方法学考虑因素
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101237
Jack Jiaqi Zhang, Zhongfei Bai, Kenneth N K Fong
To the editor: Repetitive transcranial magnetic stimulation (rTMS) is a neuroplasticity-enhancing technique that modifies brain responsiveness to various therapeutic modalities in clinical psychiatric and neurological applications.1 Furthermore, its effect can be attributed to long-term potentiation (LTP) or long-term depression (LTD)-like neuroplasticity. However, responsiveness to rTMS is largely variable in healthy and pathological brains2 and is mediated by complex biological mechanisms. Metaplasticity refers to a higher-order plasticity mechanism in which the direction and magnitude of synaptic plasticity are modified by prior neuronal activity and is believed to be a significant factor leading to the response variability of rTMS.3 According to its mechanism of action, the threshold for induction of LTP and LTD is dynamically adjusted to the level of prior neuronal activity: a low level of prior neuronal activity slides down the threshold to preferentially induce LTP. By contrast, a high level slides up the threshold to preferentially induce LTD.4 The induction of metaplasticity has been demonstrated in the human cortex using rTMS. Successively applying two identical rTMS protocols may lead to the reversal of the aftereffect of the protocol owing to the saturation of LTP/LTD and homeostatic regulation via metaplasticity. By contrast, pairing two non-identical stimulation protocols appears to induce additive neuroplastic effects through therapeutically beneficial metaplasticity induction.4 Therefore, researchers have used priming protocols to stabilise and increase the aftereffects of the subsequent conditioning session (figure 1A). A total of two kinds of priming protocols for inducing therapeutically beneficial metaplasticity, ‘preceding excitation enhances subsequent inhibition’ and ‘preceding inhibition amplifies subsequent excitation’, have been tested with conventional high-frequency/low-frequency rTMS as well as intermittent/continuous theta burst stimulation (iTBS/cTBS) in the M1 of healthy individuals, measured using motor-evoked potential (MEP).5 Figure 1 (A) Design of priming rTMS protocol and its underlying sliding threshold model: a low level of neuronal …
致编辑重复经颅磁刺激(rTMS)是一种增强神经可塑性的技术,可改变大脑对各种治疗模式的反应性,应用于临床精神和神经学领域1。此外,其效果可归因于类似长期电位(LTP)或长期抑制(LTD)的神经可塑性。然而,健康大脑和病理大脑2 对经颅磁刺激的反应性在很大程度上是不同的,并且由复杂的生物机制介导。3 根据其作用机制,诱导 LTP 和 LTD 的阈值会根据先前神经元活动的水平进行动态调整:先前神经元活动的低水平会降低阈值,从而优先诱导 LTP。与此相反,高水平的神经元活动会使阈值上升,从而优先诱导 LTP。连续应用两个相同的经颅磁刺激方案可能会导致方案后效应的逆转,原因是 LTP/LTD 饱和以及通过元弹力进行的同态调节。相比之下,将两种非完全相同的刺激方案配对使用,似乎可以通过诱导对治疗有益的元可塑性,诱导出相加的神经可塑性效应。4 因此,研究人员使用启动方案来稳定和增加后续调节疗程的后效(图 1A)。研究人员使用传统的高频/低频经颅磁刺激以及间歇/连续θ脉冲刺激(iTBS/cTBS)对健康人的 M1 进行了测试,并使用运动诱发电位(MEP)进行了测量。5 图 1 (A) 启动经颅磁刺激方案设计及其基本滑动阈值模型:低水平的神经元...
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引用次数: 0
Age-related differences in long-term potentiation-like plasticity and short-latency afferent inhibition and their association with cognitive function 长时电位样可塑性和短时传入抑制的年龄差异及其与认知功能的关系
IF 11.9 3区 医学 Q1 PSYCHIATRY Pub Date : 2024-02-01 DOI: 10.1136/gpsych-2023-101181
Qian Lu, Sisi Huang, Tianjiao Zhang, Jie Song, Manyu Dong, Yilun Qian, Jing Teng, Tong Wang, Chuan He, Ying Shen
Background The neurophysiological differences in cortical plasticity and cholinergic system function due to ageing and their correlation with cognitive function remain poorly understood. Aims To reveal the differences in long-term potentiation (LTP)-like plasticity and short-latency afferent inhibition (SAI) between older and younger individuals, alongside their correlation with cognitive function using transcranial magnetic stimulation (TMS). Methods The cross-sectional study involved 31 younger adults aged 18–30 and 46 older adults aged 60–80. All participants underwent comprehensive cognitive assessments and a neurophysiological evaluation based on TMS. Cognitive function assessments included evaluations of global cognitive function, language, memory and executive function. The neurophysiological assessment included LTP-like plasticity and SAI. Results The findings of this study revealed a decline in LTP among the older adults compared with the younger adults (wald χ2=3.98, p=0.046). Subgroup analysis further demonstrated a significant reduction in SAI level among individuals aged 70–80 years in comparison to both the younger adults (SAI(N20): (t=−3.37, p=0.018); SAI(N20+4): (t=−3.13, p=0.038)) and those aged 60–70 (SAI(N20): (t=−3.26, p=0.025); SAI(N20+4): (t=−3.69, p=0.006)). Conversely, there was no notable difference in SAI level between those aged 60–70 years and the younger group. Furthermore, after employing the Bonferroni correction, the correlation analysis revealed that only the positive correlation between LTP-like plasticity and language function (r=0.61, p<0.001) in the younger group remained statistically significant. Conclusions During the normal ageing process, a decline in synaptic plasticity may precede cholinergic system dysfunction. In individuals over 60 years of age, there is a reduction in LTP-like plasticity, while a decline in cholinergic system function is observed in those over 70. Thus, the cholinergic system may play a vital role in preventing cognitive decline during normal ageing. In younger individuals, LTP-like plasticity might represent a potential neurophysiological marker for language function. The data sets generated during and/or analysed during the current study are available from the corresponding authors on reasonable request.
背景 老龄化导致的大脑皮层可塑性和胆碱能系统功能的神经生理学差异及其与认知功能的相关性仍鲜为人知。目的 通过经颅磁刺激(TMS)揭示老年人和年轻人在类似长期延时(LTP)的可塑性和短时传入抑制(SAI)方面的差异,以及它们与认知功能的相关性。方法 这项横断面研究涉及 31 名 18-30 岁的年轻人和 46 名 60-80 岁的老年人。所有参与者都接受了全面的认知评估和基于 TMS 的神经生理学评估。认知功能评估包括对整体认知功能、语言、记忆和执行功能的评估。神经生理学评估包括 LTP 类可塑性和 SAI。结果 研究结果显示,与年轻人相比,老年人的 LTP 有所下降(wald χ2=3.98,P=0.046)。分组分析进一步表明,与年轻人相比,70-80 岁人群的 SAI 水平显著下降(SAI(N20):(t=-3.37,p=0.018);SAI(N20+4):(t=-3.13,p=0.018):(t=-3.13, p=0.038))和 60-70 岁(SAI(N20): (t=-3.26, p=0.025); SAI(N20+4):(t=-3.69, p=0.006))。相反,60-70 岁组与年轻组的 SAI 水平没有明显差异。此外,在采用 Bonferroni 校正后,相关分析表明,只有年轻组的 LTP 类可塑性与语言功能之间的正相关性(r=0.61,p<0.001)仍具有显著的统计学意义。结论 在正常衰老过程中,突触可塑性下降可能先于胆碱能系统功能障碍。在 60 岁以上的人群中,LTP 类可塑性下降,而在 70 岁以上的人群中,胆碱能系统功能下降。因此,在正常衰老过程中,胆碱能系统可能在防止认知能力下降方面发挥着重要作用。在年轻人中,LTP 样可塑性可能是语言功能的潜在神经生理学标志。本研究中生成和/或分析的数据集可向通讯作者索取。
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引用次数: 0
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General Psychiatry
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