Frontiers in Psychiatry最新文献

Objective: This study aimed to assess the impact of esketamine on perioperative anxiety, including its frequency, intensity, and score variations, across different surgical procedures by analyzing data from randomized controlled trials (RCTs).

Methods: A comprehensive literature search was performed across PubMed, Embase, the Cochrane Library, and Web of Science to identify relevant RCTs evaluating esketamine. Statistical analyses were conducted using Review Manager version 5.4 and Stata. Studies were included if they were RCTs involving anesthetized adult patients comparing esketamine with others, reporting of perioperative outcomes and sufficient data for meta-analysis. Studies were excluded for being reviews/editorials/case reports, conference abstracts, pediatric-focused, unpublished, or non-English. Primary outcomes contained change in anxiety/depression score and anxiety/depression Score. Secondary outcomes contained change in sleep/pain score and perioperation data. To assess publication bias, funnel plot visualization and Egger's test were employed.

Results: A total of eight RCTs involving 1,101 participants fulfilled the inclusion criteria. The pooled analysis indicated that esketamine administration led to a significant reduction in perioperative anxiety levels compared to control interventions (SMD = -0.36; 95% CI: -0.67 to -0.06; p < 0.0001; I² = 84%). However, no statistically significant improvements were observed in sleep parameters, pain relief, surgical or anesthetic duration, or intraoperative metrics such as fluid administration, blood loss, urine output, or adverse event rates. Sensitivity analyses suggested variability in the anxiety-related outcomes, while findings related to depression remained consistent. Subgroup evaluations indicated a lack of measurable benefit in individuals under 40 years of age, those undergoing abdominal operations, and patients receiving spinal anesthesia.

Conclusion: Esketamine shows promise in reducing anxiety during the perioperative period. Nonetheless, its effectiveness may depend on individual patient profiles and surgical settings. Further high-quality trials are needed to identify the most effective dosing regimens, delivery methods, and combination strategies to enhance efficacy and reduce side effects.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO identifier CRD420251050362.

Introduction: Autism Spectrum Disorder (ASD) presents considerable diagnostic challenges due to its heterogeneous nature and early developmental onset. In recent years, the convergence of noninvasive neuroimaging modalities such as Electroencephalography (EEG) and Functional Near Infrared Spectroscopy (fNIRS) with machine learning (ML) and deep learning (DL) techniques has opened new avenues for uncovering objective biomarkers of ASD. EEG offers millisecond level resolution of brain electrical activity, while fNIRS tracks hemodynamic responses tied to neuronal function, making the two methods complementary. This review aims to investigate the state of the art of the applications of EEG and fNIRS to ASD patients combined with ML and DL approaches.

Methods: To this goal, Scopus and PubMed databases were searched, and following the PRISMA guidelines, 27 peer reviewed studies published between 2019 and 2024 were included in the survey.

Results: The results showed consistent patterns across the studies, including alterations in neural oscillations and disruptions in connectivity within key brain regions related to social communication and cognition. However, a strong heterogeneity was assessed regarding probes montages, preprocessing workflows, and classification models employed, limiting the feasibility of a metanalysis.

Discussion: The results demonstrated the potential of DL and ML algorithms applied to EEG and fNIRS signals for early ASD assessment, supporting the development of personalized intervention strategies grounded in robust neurophysiological evidence.

Background: Body-focused repetitive behaviors (BFRBs)-including hair-pulling, skin-picking, and nail-biting-are increasingly recognized as behaviors associated with dermatologic, psychological, and social consequences. However, their prevalence in Middle Eastern populations remains underreported.

Objective: To estimate the prevalence of BFRBs in the Saudi population and to describe their demographic distribution and clinical characteristics.

Methods: A cross-sectional, community-based survey was conducted between June 2023 and July 2024. A total of 740 adults (aged 18-73 years) completed an online questionnaire incorporating the Habit Questionnaire, a brief five-item self-report screening tool assessing repetitive grooming behaviors, including type, frequency, duration, and impact. Study-defined operational criteria classified behaviors occurring ≥5 times per day for at least four weeks together with functional impairment, injury, or medical attention. Statistical analyses included descriptive summaries, Chi-square tests, and logistic regression.

Results: The prevalence of BFRB-related behaviors meeting study-defined thresholds was 29.1%. Hair-pulling behavior was reported by 19.1% of participants, skin-picking by 13.4%, and nail-biting by 4.3%. Younger age was strongly associated with these behaviors, with prevalence reaching 47.2% in the 18-20-year group and decreasing to 10.1% in participants older than 50 years (p = 0.001). Most affected individuals described symptoms persisting beyond 12 months and reported complications including interference with daily functioning, injuries, and permanent scarring. Only 5.5% had sought medical care. In multivariable analysis, age remained the strongest predictor across all behavior types; female gender was associated with higher odds of hair-pulling and lower odds of nail-biting, while educational level showed no significant association.

Conclusion: BFRBs, defined by study-specific behavioral thresholds, are common in Saudi Arabia, particularly among younger adults. Gender differences varied by behavior subtype. Despite chronicity and reported physical consequences, few individuals sought medical care. These findings highlight the need for early recognition, increased public awareness, and integration of BFRB screening into primary and mental health services.

Dysphoric Milk Ejection Reflex (D-MER) is a distinct neurobiological condition characterized by negative alterations in mental state in response to milk letdown during lactation. Symptoms vary by patient and can include feelings of sadness, anxiety or agitation. Importantly, the symptoms are brief, typically lasting no more than 5 minutes. Prevalence has been found between 6 and 27% of lactating women, but studies show heterogeneity, due in part to inconsistent definition. D-MER is not currently classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD), which presents a challenge for researchers of the condition. The pathophysiology of D-MER is not well understood, but may be mediated by hormonal changes. In an attempt to begin to formalize classification of this condition, the authors explore the association with another recently classified, hormonally mediated and time sensitive condition: premenstrual dysphoric disorder or PMDD. Like D-MER, PMDD is characterized by heterogeneous symptoms that occur on a predictable timeline. The recent addition of a formal diagnostic category into the DSM helped facilitate an expansion of research into etiology and treatment of the condition. This paper will explore a pathway to classification of D-MER based on the current research using the framework of the DSM-5 diagnostic criteria for PMDD. We will conclude by outlining future research priorities that will help to better define this condition and differentiate it from other causes of emotional distress during lactation.

Purpose: To explore the Effects of Exercise Supplementary to Standard Therapy on Cognition and Sleep in Depression.

Methods: We randomized 273 inpatients with first-episode severe depression, 234 completed 6 weeks, conventional treatment, conventional treatment combined with aerobic exercises and conventional treatment combined with stretching or resistance training exercises group. Hamilton Depression Scale-24 (HAMD24), Pittsburgh Sleep Quality Index (PSQI), Montreal Cognitive Assessment (MOCA), Chinese Version of the Trail-Making Test (C-TMT), and Stroop Color and Word Test (SCWT) were used to evaluate the patients respectively before and after intervention. The primary analysis estimated was the between-group difference in post-treatment scores at 6 weeks under randomized allocation (post-status estimated); within-group changes were summarized descriptively.

Results: After intervention, HAMD24, PSQI, C-TMT-A, and C-TMT-B scores of patients in each group were all lower than those before intervention. HAMD24, PSQI, and C-TMT-A scores of patients in Groups B and C showed lower than those of Group A. C-TMT-B score of patients in Group B was lower than that of Group C, and the score of Group C was lower than that of Group A. MOCA, SCWT scores of patients in each group were higher than those before intervention. Stroop Word and Stroop Color scores were significantly higher in Groups B and C than in Group A. MOCA and Stroop Color-Word scores of patients in Group B were higher than those of Group C. However, scores of Group C were higher than those of Group A.

Conclusion: Both aerobic exercises and stretching or resistance training exercises as adjuncts to conventional treatment improved depressive symptoms, sleep quality, and cognitive function in patients with first-episode severe depression. Patterns were consistent with greater improvement in select executive-function measures in the aerobic arm; confirmation with baseline-adjusted analyses is warranted.

Background: Attention Deficit/Hyperactivity Disorder (ADHD) and internet addiction (IA) are common among college students and often co-exist. This study investigated the relationship between ADHD symptoms, executive dysfunction, insomnia, and IA in Chinese college students.

Methods: A cross-sectional study was conducted in June 2024 at six universities in Hunan Province, China. Demographic data and symptoms of ADHD, IA, executive dysfunction, insomnia, and physical activity were collected via interviews and self-reported questionnaires. Physical activity level was further quantified and categorized using metabolic equivalents (METs) method. Mediation models were performed to explore the path from ADHD to IA and the role of physical activity in IA symptoms.

Results: Among 1925 students, 12.52% had ADHD symptoms, and 14.03% had IA symptoms. ADHD symptoms were related to IA symptoms (total effects: 0.38, p < 0.001; direct effect: 0.111, p = 0.003), mediated by insomnia (0.161, p < 0.001) and executive dysfunction (0.108, p < 0.001). Compared with no physical activity, moderate-level and high-level physical activities were negatively correlated with IA symptoms, with total relative standardized effects of -0.18 (p = 0.001) and -0.42 (p<0.001), respectively. The relative direct effect of high physical activity levels on IA symptoms was -0.29 (p<0.001), regardless of mediation by insomnia (-0.056 (95%CI, -0.094 to -0.021)) and executive dysfunction (-0.067 (95%CI, -0.105 to -0.033)).

Conclusion: ADHD and IA symptoms are prevalent among Chinese college students. Executive dysfunction and insomnia mediate the relationship between ADHD and IA symptoms. Moderate and high-level physical activities were associated with reduced risk of IA symptoms, mediated by executive dysfunction and insomnia. Physical activity may help mitigate IA symptoms in college students.

Background: Transgender and gender-diverse (TGD) individuals face high levels of stigma, discrimination, and psychological distress, which are amplified in carceral settings. Italian prisons have introduced specialized sections for TGD inmates; however, limited empirical evidence exists on their function and the psychiatric, social, and institutional challenges emerging within them.

Methods: A case-informed qualitative design was applied to four TGD inmates housed in a specialized prison section in Northern Italy. Data were derived from routine psychiatric and endocrinological assessments, administrative documentation, informal and semi-structured interviews, and multidisciplinary team observations. A thematic cross-case synthesis was conducted to identify institutional determinants of distress and barriers to gender-affirming care.

Results: Three themes emerged. (1) Context-dependent fluidity in gender identity recognition and categorization: institutional frameworks relied on static binary models, contributing to confusion and psychological strain. (2) Intra-group tensions within designated housing: discrepancies in transition pathways, administrative criteria, perceived authenticity, and the presence of sexual minority inmates generated conflict and social exclusion. (3) Gaps in gender-affirming and psychiatric care: logistical barriers, limited staff training, reliance on telemedicine, and inconsistent access to hormone therapy disrupted continuity of care and exacerbated distress.

Discussion: These findings illustrate how rigid systems and ambiguous housing policies may reinforce minority stress and undermine psychiatric well-being. Protective units can inadvertently reproduce exclusion when gender identity and sexual orientation are conflated or when criteria for placement remain unclear. Correctional systems should adopt flexible gender-recognition procedures, implement trauma-informed practices, develop distinct housing policies, establish standardized pathways for gender-affirming care, and provide specialized staff training to ensure dignity, safety, and improved mental health outcomes for TGD inmates.

Substance use disorder (SUD) poses significant challenges to public health, the economy, and social safety. Delay discounting (DD) is one form of impulsivity which is a risk factor for SUD and other mental health disorders. Moreover, when faced with immediate rewards, individuals with SUD exhibit increased DD compared to healthy controls. Fortunately, previous studies have shown that EFT, referring to vividly imagining potential future events in specific scenarios based on an individual's current experiences, can effectively reduce DD and substance use in individuals with SUD. In this process, the potential regulatory mechanism of EFT may involve extending the temporal window and decreasing the construal level of future events. Most promising avenues to pursue in future studies may include manipulating participants' factors (e.g., sample size, adherence to diagnostic criteria, comorbidity with other mental diseases), conducting longitudinal studies and exploring the neural regulatory mechanisms of EFT on DD among individuals with SUD. Further research should also examine the effects of both positive and negative emotional valence in EFT interventions to determine how different types of future thinking influence impulsivity and decision-making. This would help us develop more applicable theoretical models and improve the effectiveness of EFT in intervening with SUD.

Objective: This study addresses the unclear dynamic mechanisms underlying social interactions in children with autism spectrum disorder (ASD) by constructing a structured play observation framework.

Methods: By combining latent class analysis (LCA) and temporal analysis techniques, this study systematically analyzed the heterogeneous characteristics of social behavioral sequences. Using a longitudinal tracking and cross-sectional design, multimodal data (video coding and physiological indicators) were collected from 60 children with ASD and 40 typically developing (TD) children.

Results: The behavioral sequence complexity of the ASD group was significantly lower than that of the TD group, exhibiting an "avoidance-rigid" cyclical pattern. The LCA model identified three behavioral patterns: high interaction, medium interaction-rigid, and low interaction-high avoidance. The low interaction-high avoidance group demonstrated the poorest intervention response rate.

Conclusion: This study innovatively applies dynamic systems theory to the ASD field, demonstrating that behavioral sequences can serve as intervention targets. It advances evaluation tools from static description to dynamic prediction, providing a scientific basis for personalized intervention planning. The integration of structured observation and multimodal data analysis deepens the understanding of the dynamic mechanisms underlying social impairments in ASD and holds significant theoretical and practical value.

Mental disturbances and related symptoms in the perinatal period present a challenge to patients and providers alike, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis thanks to guidelines recommending the use of validated screening measures used at perinatal visits. However, patients report several concerns when completing these screeners and providers report barriers in addressing the results. To address barriers and enhance the PMH screening experience, our team of clinicians and researchers propose a tool - the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid - to be given to the patient at the same time as a PMH screener. The PMH Connect provides brief anticipatory guidance about PMH symptoms, normalizing trauma-informed language about prevalence, and provides a connection to resources in a supportive, unobtrusive manner. PMH Connect helps patients feel heard and supported and provides resources before patients need them, which decreases the burden on patients and providers alike. Inspired by the Cycle to Respectful Care framework, PMH Connect is designed to shift power to patients themselves, as valued experts on their own care team, by offering them connections to information and resources through this simple tool. Our hope is that PMH Connect will bridge many of the barriers to effective PMH screening, assessment, and treatment by improving patients' experiences and outcomes with the ultimate goal of optimizing screening effectiveness and care connection to improve maternal and infant health.