Frontiers in Psychiatry最新文献

Background: The development of numerous demoralization assessment tools has significantly contributed to the field, with the Demoralization Scale being the most frequently utilized. Nevertheless, the inconsistency in cutoff values for these tools hinders accurate estimation of demoralization, underscoring the need for research to determine an optimal threshold. This study examined the heterogeneity of demoralization syndrome among cancer patients in China, aiming to establish an optimal cut-off value for the mandarin version demoralization scale.

Method: A cross-sectional study recruited 971 cancer patients from Hunan Province between June 14, 2022 and June 13, 2023. Latent profile analysis was used to identify distinct profiles, and receiver operating characteristic curve analysis determined the optimal cut-off point.

Result: Three distinct profiles were identified: "minimal demoralization - meaningful" (22.3%), "moderate demoralization" (59.9%), and "severe demoralization - hopelessness" (17.9%). The mandarin version demoralization scale showed high accuracy (AUC = 0.995) with an optimal cut-off point of 23.5 (sensitivity: 98.9%, specificity: 94.8%, and accuracy: 93.7%).

Conclusion: The distinct profiles highlight varying demoralization syndrome in cancer patients. Notably, the Mandarin Version Demoralization Scale exhibits excellent properties, with a cutoff of 23.50 for Chinese cancer patients. Our study deepens understanding, offering insights for standardized clinical classifications, enabling cross-setting comparisons.

Introduction: Non-verbal behaviours (NVBs) reveal information about mood and emotions, potentially providing an objective means to measure and monitor early treatment responses. Previous research has examined NVB changes during treatment in patients with depression and psychosis but a systematic evaluation of the evidence is lacking. Furthermore, this review could inform the fast moving field of digital and precision psychiatry due to the use of AI-based technology that could transform the potential of NVBs as reliable biomarkers for treatment response.

Methods: Medline, Embase, PsycINFO and CINAHL were searched in June 2024. Included papers studied adults diagnosed with depression or schizophrenia and measured NVBs at least twice during separate clinical interviews. Outcomes of interest were changes in clinical symptoms and NVBs following treatment initiation. Treatment strategies included hospitalisation, pharmacological, psychological, neuromodulatory, other non-standardised interventions, or a combination of approaches. Two reviewers independently extracted data and assessed risk of bias. The protocol for the review was registered on PROSPERO.

Results: 20 papers were identified; 15 on depression, two on schizophrenia and three evaluating both conditions separately. Methodological variations across studies made comparisons challenging. NVBs consistently associated with improvement in depression symptoms included: increased smiling, facial expressivity, and amplified head and body movements. Results across studies were more consistent when considering general categories of behaviour, versus discrete facial behaviours. No commonalities were observed in NVB changes over time for patients with schizophrenia.

Discussion: The existing evidence is presently insufficient to establish distinct behavioural profiles for clinical improvement depression or schizophrenia. Despite implicit challenges, there is considerable future scope in the evaluation of NVBs as predictors of clinical outcomes or change.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022368599.

Introduction: Schizophrenia is a severe and chronic psychiatric disorder marked by a complex and heterogeneous array of symptoms, including positive symptoms (such as hallucinations and delusions), negative symptoms (such as emotional blunting and social withdrawal), and cognitive deficits. These symptoms result in profound and persistent impairments across multiple domains of functioning, including self-care, interpersonal relationships, family life, and occupational performance. Therefore, evaluation of functionality in schizophrenia has become an important objective for monitoring the clinical and therapeutic outcome of the patients.

Methods: This review identifies and evaluates the development and use of functioning assessment scales in schizophrenia from 1976 to 2024. A comprehensive search of four major medical databases (PubMed, NIH, Wiley Online Library, and Springer Nature Link) covering studies published over nearly five decades yielded 42 distinct instruments that met predefined inclusion criteria.

Results: Each scale was examined in terms of its clinical utility, psychometric robustness, domains assessed, and the extent to which it integrates the perspectives of patients, clinicians, and caregivers. The analysis revealed a wide variation in the domains covered by these tools, many focusing heavily on either clinical or social aspects of functioning, often neglecting others such as occupational or familial roles. Additionally, the usability of several instruments in routine clinical settings was limited by their length or complexity.

Discussions: These findings underscore the need for more streamlined, multidimensional, and user-friendly assessment tools that are both scientifically rigorous and practically applicable. The review highlights the importance of adopting a holistic approach to functional recovery in schizophrenia-one that considers not only symptom reduction but also quality of life and reintegration into the community. Future scale development should prioritize the inclusion of input from all key stakeholders and aim to capture the nuanced realities of daily functioning in individuals living with schizophrenia.

Background: Precision medicine promises to improve treatment outcomes by tailoring interventions to patients' individual characteristics. However, the use of precision medicine tools requires patient acceptance, which remains underexplored. This qualitative study investigated factors influencing patient perspectives on a multimodal precision medicine algorithm to predict antidepressant response in patients suffering from Major Depressive Disorder (MDD).

Methods: To explore patients' perspectives on the use of a multimodal algorithm, semi-structured focus groups were conducted with 44 patients diagnosed with moderate to severe depression across three European sites (Germany, Poland, Italy) in the PROMPT study. Discussions were transcribed and translated into English for analysis. A qualitative, structured content analysis approach was then used to analyse the data.

Results: Patients' perspectives on using a multimodal algorithm in MDD revealed a complex interplay of decision-making factors: while perceived clinical benefits, such as a reduction in trial-and-error prescribing and reassurance, promoted acceptance of the algorithm, concerns about cost, waiting time and the emotional impact of unfavourable results tended to discourage acceptance. Patients' general beliefs about mental illness and its treatment shaped their attitudes toward the application of the algorithm. Many participants emphasised the importance of trust in physicians and preferred testing within the context of an established therapeutic relationship. Misconceptions about the algorithm's accuracy and capabilities, and fears of medical reductionism, were common.

Conclusions: While patients are open to the use of a multimodal precision medicine algorithm for MDD, they emphasised the need for individualised, transparent communication and emotional support. The results highlight the importance of patient-centred communication strategies and guidelines for the ethical implementation of precision psychiatry.

Purpose: To investigate the rehabilitative effects of modified psychomotor therapy (mPMT), which incorporates traditional Chinese healthcare exercises, on the self-efficacy, psychiatric symptoms, quality of life, and social functioning of individuals with schizophrenia during the community rehabilitation period.

Methods: A total of 96 individuals with schizophrenia, who were being managed during community rehabilitation period at Yangpu District, were randomly and equally divided, using the simple random number method, into two groups: the intervention group (mPMT) and the control group (Control). The control group received routine community mental health services, including psychiatric medication, follow-up visits from the community family doctor teams, health education and routine community rehabilitation services, whereas the mPMT group received psychomotor therapy alongside these services above for a period of six months. The self-efficacy of individuals with schizophrenia was primarily assessed using the General Self-Efficacy Scale (GSES). Psychiatric symptoms, social disability and quality of life were respectively assessed using the Positive and Negative Syndrome (PANSS), the Social Disability Screening Schedule (SDSS) and the Schizophrenia Quality of Life Scale (SQLS).

Results: After six months, the within-group GSES scores were significantly higher in both the control and mPMT groups compared to the baseline scores (p < 0.0001), while the SQLS and SDSS scores were significantly lower (p < 0.001). After 6 months of intervention, PANSS, SQLS and SDSS scores were significantly lower in the mPMT group than in the control group (p < 0.001).

Conclusion: mPMT serves as an effective complementary intervention to alleviate psychiatric symptoms, enhance self-efficacy, and improve the quality of life for individuals with schizophrenia in community rehabilitation.

Risk in forensic mental health is often shaped as an individual issue. But what if risk is also produced by the systems meant to provide care and safety? This paper introduces the Risk in Systems Framework, a conceptual model to understand how risk emerges not just within people, but also through institutional practices and structural inequalities. Drawing on established models from criminology, psychology, and public health, the framework explores risk across three levels: the individual, the system, and the broader social structures. It helps identify how policies, professional norms, and historical legacies can shape who is labelled risky and what responses are considered appropriate. By shifting the focus from "risky individuals" to "risky systems," this approach supports more responsive care for people in forensic mental health settings.

Background and aims: Maladaptive daydreaming (MD) is a pattern of excessive, compulsive fantasizing associated with functional impairment. While its classification remains debated, increasing evidence suggests that it may be understood as an addictive form of emotion regulation. This study aimed to develop and validate a new self-report tool, grounded in the behavioral addiction framework, for screening and assessing the severity of MD, and to examine its potential clinical utility.

Methods: A mixed-clinical (N = 182) and non-clinical (N = 231) sample completed the Addictive Daydreaming Scale (ADS) in two forms: a 20-item full version (ADS-20) and a 5-item screening test (ADS-5), together with established measures of MD, quality of life, and self-rated impact of daydreaming.

Results: Psychometric analyses confirmed that both the ADS-20 and ADS-5 demonstrated high reliability and strong content, criterion, and construct validity. ADS scores were more strongly correlated with both the psychological and social domains of quality of life than Maladaptive Daydreaming Scale scores, supporting its sensitivity to functional impairment. Cut-off scores of ≥42 (ADS-20) and ≥8 (ADS-5) showed good accuracy for identifying clinically significant cases.

Conclusions: The ADS-20 and ADS-5 are reliable, valid instruments for identifying and assessing addictive features of maladaptive daydreaming. Their use may support improved clinical detection, assessing the severity of MD and help conceptualize it within the behavioral addictions framework.

The transition from childhood to early adolescence is a critical developmental period, particularly in rural areas where unique factors play a significant role. This study examined the interplay of peer and family factors on the mental health, including anxiety and depression, of 694 rural Chinese children in the transition to adolescence (aged 10-14). This study employed a quantitative design, analyzing data from 16 rural schools across seven provinces using Mixed Graphical Model (MGM) and Gaussian Graphical Model (GGM) network analyses to explore the relationships between variables related to family factors, peer relationships, anxiety, depression, and behavioral problems. Network analysis revealed that depression was a central node, and peer relationships had a greater impact on the mental health of these children than family factors. There was a significant correlation between depression and anxiety (weight = 0.55). Peer relationships were negatively associated with depression (weight = -0.31) and positively associated with father involvement. In contrast, the network shows that the experience of being left behind was not directly associated with mental health outcomes. Further analysis of the depression network revealed that negative mood was a central node. This study highlights that peer relationships have a far stronger connection to the mental health of rural Chinese children than family factors. Depression, and specifically negative mood, was central to the network, emphasizing the need for interventions that focus on improving peer interactions and addressing core depressive symptoms.

Depression is a frequently co-occurring condition in autism spectrum disorder (ASD). Notably, autistic individuals are approximately four times more likely to experience depression than the general population. Difficulties in emotion regulation, inhibitory control, and social skills, common in autistic individuals, are thought to contribute to increased risk and vulnerability to depression. The present study sought to examine the prevalence of depressive symptoms and its cognitive correlates in a sample of autistic and neurotypical (NT) children and adolescents (53 ASD and 43 NT). Data were collected using parent-report questionnaires that assessed depressive symptoms, executive functions, and social skills. Group differences and the relationship between depressive symptoms and cognitive measures were assessed by t-test and linear regression analyses respectively. The results indicated a significant increase in depressive symptoms among the autistic, compared to NT, participants (p < 0.0001). Moreover, emotion regulation and social communication and interaction were significantly associated with depressive symptoms in both groups (p < 0.05). Additional analysis revealed that parental stress did not influence the relationship between executive functioning and interaction and depressive symptoms in both groups. But parental stress influenced the relationship between social communication and interaction and depressive symptoms. The present study highlights the dual contributions of emotional regulation and SCI to depression in both autistic and NT population. Furthermore, underscore the importance of addressing emotion regulation and social communication in identifying risk factors of depression and developing intervention strategies for depression.

Introduction: Preventing vaccine hesitancy is an important effort by the clinician. The present study aimed to evaluate the factorial structure and psychometric properties of the Vaccination Fear Scale (VFS) in a Polish sample, as well as to examine its measurement invariance across sex and its associations with psychological distress.

Methods: A sample of 455 adults from the general population, broadly representative of the general Polish adult population, (Mean age = 37.05, SD = 13.14; 72.3% female) was recruited. Participants completed the seven-item version of the VFS. A subsample of 153 individuals also completed the 21-items Depression, Anxiety, and Stress Scale (DASS-21). Confirmatory factor analyses (CFA) were conducted to compare unidimensional, two correlated factors, and second-order two-factor models for 7-items and 6-items versions.

Results: Results indicated that the 6-item version of the VFS (VFS-6), excluding item 5, provided superior fit compared to the 7-item version. The best-fitting model was a two-factor correlated structure (Cognitive factor: items 1, 2, and 4; Somatic factor: items 3, 6, and 7), confirming a clear cognitive-somatic structure. Measurement invariance analyses supported strict invariance between sexes. Internal consistency was high for both the total scale and its subfactors, and convergent and discriminant validity were satisfactory.

Conclusion: Correlations with DASS-21 scores were low and non-significant, suggesting that vaccination fear is largely independent of general psychological distress measured as depression, anxiety and stress. These findings demonstrate that the VFS-6 is a reliable and valid instrument for assessing fear of vaccination in the Polish population. The results also clarify the role of item 5, and provide evidence for strict sex invariance, offering a robust tool for research and intervention planning.