Frontiers in Psychiatry最新文献

Introduction: This study aimed to explore the perspectives of occupational therapists and individuals with lived experience of mental health challenges regarding which aspects of participation in meaningful activities should be represented in digital twins, and how these aspects should be visualized.

Methods: We conducted a qualitative descriptive study involving 14 semi-structured interviews with occupational therapists and individuals with lived experience of mental health challenges. Interviews were transcribed verbatim and analyzed using inductive content analysis.

Results: Participants identified four main aspects to visualize in digital twins focusing on participation in meaningful activities: 1) the degree of being present and in-the-moment, 2) related or resulting experiences of being present and in-the-moment (including relaxation and calmness; fulfillment, purpose, joy, and playfulness; feeling vitalized; connection with oneself, others, and the world), 3) the energy needed and the energy gained from participation, and 4) the influence of the context. In addition, results revealed two main approaches for how these aspects should be visualized: 1) symbols and charts to visualize the now-situation, and 2) graphs for visualization over time.

Discussion and conclusion: Results identified four aspects of a participation in meaningful activities to be represented in digital twins. Those align with, and extend, existing literature on participation and recovery experiences. For the visualization of those aspects in digital twins, participants emphasized the importance of integrating both immediate feedback and longitudinal tracking of participation experiences.

Suicide remains a critical global public health challenge, with distinct prevalence patterns and risk factors observed across different cultural contexts. While evidence-based prevention strategies, such as Cognitive Behavioral Therapy (CBT), crisis hotlines, and gatekeeper training, have been developed predominantly in Western settings and have demonstrated efficacy, their application in non-Western populations faces unique cultural hurdles. This perspective article examines the limitations of applying individualistic suicide prevention models without sufficient adaptation to East Asian cultural contexts, which are often characterized by "shame-honor" dynamics and collectivist values. We acknowledge the significant contributions of existing Western frameworks but argue that a reliance on these models, if unexamined, may overlook specific barriers to help-seeking, such as the intense stigma associated with "loss of face" and the perception of mental distress as a burden to the family. By analyzing the "cultural mismatch" between the Western independent self and the East Asian interdependent self, this article calls for a paradigm shift toward "cultural grounding." We propose that the field must move beyond superficial adaptation toward the co-creation of interventions that integrate indigenous cultural narratives and social structures. This approach aims not to replace existing evidence-based practices but to enhance their relevance and accessibility, ensuring that suicide prevention strategies are truly responsive to the diverse realities of global populations.

Background: Neuroleptic malignant syndrome (NMS) is a rare yet life-threatening disease that is often induced by antipsychotic medications.

Case presentation: In this study, we describe a case of a 13-year-old female who developed NMS following promethazine use during general anesthesia. This is expected to provide clinicians, particularly anesthesiologists, with crucial insights that will improve the perioperative identification and management of this condition. The patient manifested classic clinical features of NMS, including hyperpyrexia, autonomic dysfunction, and generalized rigidity. However, the patient's serum creatine phosphokinase (CPK) levels were within normal limits, demonstrating the heterogeneous presentation of the disorder. The main interventions included drugs targeting to achieve airway control, physical cooling, hemodynamic stabilization, and symptomatic management, which promoted the patient's gradual recovery.

Conclusion: This case illustrates that due to individual variations, even standard drug dosages may induce neuroleptic malignant syndrome (NMS). Notably, NMS lacks specific laboratory findings, and its diagnosis must rely on clinical symptoms to avoid delays in early identification and treatment.

Personality disorders (PD) are common and debilitating psychiatric conditions, often characterized by severe interpersonal and self-dysfunction. Borderline personality disorder (BPD) is the most studied PD, with treatments like Good Psychiatric Management (GPM) demonstrating effectiveness. To address the current state of the personality disorder field, where most evidence-based treatments have been developed using a categorical approach, while the most empirically supported approach is the dimensional one, we developed an adaptation of GPM (GPM-extended) integrating concepts of dimensional personality dysfunction into an established therapeutic framework. This prospective "here-there" study will compare GPM-extended with standard GPM in two outpatient facilities. This methodological choice is due to organizational and institutional limitations. Participants (≥18 years) meeting BPD criteria per the SCID-II will be included. The GPM-extended group incorporates a dimensional diagnostic framework focusing on three personality dilemmas (rejection/abandonment fears, self-esteem dysregulation, and perfection/control issues), with tailored psychoeducation and treatment priorities. The standard GPM group will follow the validated GPM protocol, emphasizing interpersonal hypersensitivity and standard psychoeducation. Both groups will receive weekly individual therapy and group interventions for one year. Between-group differences at 1-year follow-up will be assessed using multiple regression models adjusted for baseline scores. The primary outcome is the change in BPD symptom severity (ZAN-BPD). Secondary outcomes include personality functioning, traits, and various clinical dimensions such as impulsivity, emotional regulation, and social functioning. All patients having initiated the program and having initial data will be included in the analysis, with multiple imputations for missing data and sensitivity analyses planned. Altogether, this study seeks to evaluate the feasibility and efficacy of integrating dimensionality into GPM, offering a pragmatic pathway to improve PD treatment and bridging gaps between evidence-based conceptualizations and treatments of PD.

Clinical trial registration: ClinicalTrials.gov, identifier NCT06913738.

Introduction: Earthquakes can cause substantial psychiatric morbidity including Post-Traumatic Stress Disorder (PTSD). While direct exposure effects are well known less is understood about relapse after indirect exposure. Following the 2023 Kahramanmaraş earthquakes clinicians observed renewed distress among survivors of the 2020 Aegean Sea earthquake. Understanding how media exposure individual factors contribute to symptom reactivation is important for post-disaster care. This study investigated factors linked to PTSD symptom relapse after repeated disaster exposure.

Method: This prospective quantitative study (February 2023-February 2024) recruited patients from a psychiatry outpatient clinic following the Kahramanmaraş earthquakes. Individuals with earthquake-related complaints who had also experienced the 2020 Aegean Sea earthquake were enrolled. Post-traumatic stress symptoms were assessed using the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at baseline and at 1, 3, 6, 9, and 12 months. Resilience was measured using the Resilience Scale for Adults (RSA) at baseline. Sociodemographic and clinical variables, including prior psychiatric treatment and media exposure type, were recorded. Multivariate analysis of variance was used to examine longitudinal symptom trajectories and predictors.

Results: The study included 87 participants (mean age = 48.8 ± 12.5yrs), the majority were female (85%). Following the Aegean Sea earthquake, 45% of participants received psychiatric treatment, with loss experience being the only significant predictor of treatment seeking (χ² = 14.90, p <.001). After the Kahramanmaraş earthquakes, 74.7% received psychiatric treatment. A significant effect of time on PCL-5 symptom severity across the 12-month follow-up (Pillais Trace = .40, F = 7.32, p <.001). Age and resilience were independently associated with PTSD severity, with resilience showing the strongest effect (F = 40.24, p <.001). Higher PCL-5 scores among those primarily exposed to traditional media (F = 5.11, p = .027), symptom trajectories did not differ over time.

Conclusion: This study shows that indirect exposure to large-scale disasters can shape symptom trajectories in previously affected individuals. Resilience served as a protective factor, while prior treatment indicated both vulnerability and adaptive potential. Media exposure type also influenced symptom severity. These results highlight the value of assessing resilience, treatment history, and media use in trauma-informed care after repeated disaster exposure.

Chronic tinnitus presents a psychosomatic paradox: while the perceptual characteristics of the sound are often similar across individuals and typically linked to hearing loss, the distress it evokes differs substantially. This distress predicts the experiential quality, persistence, and chronification of tinnitus perception, thereby shaping what is recognised as chronic tinnitus or tinnitus disorder in clinical practice. In conceptualizing distress, two interconnected processes of medicalisation can be observed: first, the framing of distressing tinnitus as a medical disorder in its own right; and second, the framing of distress itself as a psychiatric "comorbidity." However, the dominant medical-descriptive frameworks in psychiatry that underpin these practices rely on atheoretical, categorical systems to classify emotional distress. These systems have well-documented limits in reliability, validity, and clinical utility and tend to privilege biomedical explanations over psychosocial context. At this juncture, the current paper examines three conceptual approaches to distress: (1) medical-nomothetic-descriptive, (2) psychological-nomothetic-descriptive, and (3) psychological-idiographic-descriptive - which becomes explanatory upon considering individuals' life contexts, meaning-based appraisals, and symptom functions. For both clinical and research practice in chronic tinnitus, we argue for a shift towards psychological-explanatory-idiographic models that account for person-specific interactions of vulnerability, stress , emotions, and coping (VSEC), linked through personal meaning. This aligns with a broader momentum towards idiographic, process-based therapies as the future of psychological intervention. Although meaning-centred formulations challenge nomothetic research methodologies, they offer clearer clinical reasoning and help avoid unhelpful medicalisation beyond somatic factors which contribute to initial symptom onset.

Background: Schizophrenia is a chronic mental disorder and one of the greatest contributors to the global burden of disease. This study aimed to analyze the global burden of schizophrenia from 1990 to 2021 and predict its future trends.

Methods: Data from the 2021 Global Burden of Disease (GBD) study were used. Trend analysis was conducted using the estimated annual percentage change (EAPC), Joinpoint regression, and age-period-cohort analysis. Future projections were generated using the Bayesian age-period-cohort (BAPC) model and time-series machine learning (ML) models.

Results: 2021, schizophrenia was estimated to affect approximately 23.6 million individuals worldwide, with 1.22 million new cases reported globally. This disorder accounted for 14.82 million disability-adjusted life years (DALYs) lost. From 1990 to 2021, the age-standardized incidence rate (ASIR) exhibited a declining trend with an EAPC of -0.04% (95% UI: -0.04% to -0.03%), whereas the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life years rate (ASDR) demonstrated upward trajectories, showing EAPCs of 0.03% (95% UI: 0.02% to 0.04%) and 0.04%(95% UI: -0.03% to -0.05%), respectively. The peak age of onset was 20-24 years, while prevalence and DALYs peaked at 30-34 years, with males exhibiting a higher disease burden. The ARIMA, PROPHET, and Elastic Net models demonstrated superior predictive performance for forecasting future trends of global ASIR, ASPR, and ASDR. Projections suggest a continued global decline in ASIR, while ASPR and ASDR are expected to rise in the future.

Conclusion: Our research indicates that the ASIR, ASPR, and ASDR of schizophrenia exhibit significant correlations with gender, socio-demographic index (SDI) and regions. From 2022 to 2036, while the global ASIR of schizophrenia may decline, both the ASPR and ASDR are projected to rise. The escalating disease burden of schizophrenia poses a significant challenge for countries across all development levels.

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is recognized as a significant causative element in the emergence of childhood-onset obsessive-compulsive disorder (OCD) and movement disorders, including tic disorders, and choreiform movement. It is associated with various behavioral and psychiatric manifestations in children, such as separation anxiety disorder, body dysmorphic disorder, attention deficit hyperactivity disorder, and eating disorders. We describe a unique case of progressive weight loss in a previously healthy 13-year-old child who had a sudden and dramatic onset of refusal to eat, induction of vomiting, emotional liability, anxiety disorder, and OCD over 6 months following fever and pharyngitis. His workup showed an elevation of antistreptolysin O (ASO) titer with a negative throat swab. PANDAS was considered. His irritability improved after a course of antibiotics, and abatement of all symptoms and progressive weight gain occurred after a course of intravenous immunoglobulin (IVIG) followed by monthly benzathine penicillin injections. This report could help to increase awareness among physicians, highlight the importance of early diagnosis, and promote treatment of PANDAS among patients who present with a combination of eating disorders and OCD.

Background: A neurodiversity-informed approach recognizes the perspectives and experiences of autistic people from an insider perspective, yet little attention has been given to adapting qualitative methods to account for the impact of cognition, sociality, and communication style of both interviewers and participants. The aim of this paper was to contribute to the development of autistic-friendly interviewing in a group interview space.

Methods: The paper is a collective reflexive pilot study, exploring experiences of autistic interviewer and autistic participants in group interviews. The method followed five steps, from deciding what type of interview questions to use to test them in the group interviews. An autistic interviewer conducted three group interviews, each with two to three autistic participants. Interviews and analyses were conducted in Swedish, and the data were then translated into English by the authors.

Results: The study identified key insights around four areas: participants' mixed views on the interview guide, the need to accommodate autistic processing styles, the importance of recognizing autistic forms of sociality, and the significance of conducting interviews within an autistic-friendly space that fosters comfort and understanding.

Conclusion: The paper outlines step by step the procedure of conducting group interviews with autistic people. We illustrate ways to capture the possibilities of autistic-friendly interviewing by working with-rather than against-autistic cognition, sociality, and communication styles in interviews with autistic people.