Frontiers in Psychiatry最新文献

Objectives: The 7-item Hamilton Depression Rating Scale (HAM-D7) is commonly used to assess depression severity and remission; however, its standard cut-off scores may not be optimal for elderly populations. This study aimed to establish GRID-HAM-D7 remission thresholds among elderly Thai patients diagnosed with depressive disorders, including both any depressive disorder and major depressive disorder (MDD).

Methods: A total of 803 elderly participants were recruited from four tertiary care hospitals across Thailand as part of a larger psychiatric study. Diagnoses were determined using the Mini International Neuropsychiatric Interview, and depression severity was assessed via the GRID-HAM-D7. Statistical analyses, including sensitivity, specificity, predictive values, and Receiver Operating Characteristic curves, were performed to determine optimal remission cut-off scores.

Results: For any depressive disorder, a GRID-HAM-D7 score of ≤ 4 yielded sensitivities of 88.86% and specificity of 77.66%. In major depressive disorder, the optimal threshold was ≤ 6, resulting in 91.68% sensitivity and 79.73% specificity. Both values surpassed the diagnostic accuracy of conventional lower thresholds. These results suggest that higher GRID-HAM-D7 remission cut-offs better reflect depressive symptomatology in older adults.

Conclusions: The study underscores the necessity of tailoring standardized assessment tools for specific populations to enhance clinical management and decision-making in geriatric psychiatry.

Deprivation of sleep (DS) is widespread in modern societies and is associated with cardiometabolic, cognitive, and psychiatric disturbances. Acute DS has also been reported to produce short-lived improvements in mood in some individuals with depression, suggesting the involvement of specific biological mediators. Ghrelin, a stomach-derived peptide with central actions in hypothalamic and limbic circuits, has emerged as a candidate linking DS with alterations in sleep, circadian regulation, mood, and cognition. Both acylated and unacylated isoforms exhibit distinct biological activities, and accumulating evidence points to roles in sleep architecture, stress responsivity, and neuroplasticity, as well as in disorders such as insomnia, obstructive sleep apnea, and narcolepsy. Experimental studies indicate that DS frequently coincides with changes in circulating ghrelin, although findings remain heterogeneous and influenced by methodological and contextual factors. Overall, ghrelin may contribute to the pathways through which DS influences emotional regulation and cognitive functioning. A more detailed understanding of its isoform-specific, sex-dependent, and circadian-stage effects could help guide future research and support the development of therapeutic approaches that complement existing strategies for mood and sleep disorders.

Objective: Xanomeline and trospium (XT) is a novel medication for schizophrenia that was approved by the United States (U.S.) Food and Drug Administration (FDA) in September 2024. The purpose of this study is to evaluate the effectiveness and safety of using XT in the Texas state hospital setting.

Methods: Data were analyzed retrospectively from five hospitals within the Texas Health and Human Services Commission state hospital system. Adults aged ≥ 18 years administered XT between October 2024 and October 2025 were included. A chart extracted Clinical Global Impression (CGI) of Severity of Illness/Improvement was used to determine XT effectiveness. Patient demographics, clinical characteristics and documented adverse effects are reported.

Results: All patients (N = 20) had treatment-resistant schizophrenia and were classified as markedly or severely ill prior to XT initiation. All patients except one were prescribed ≥ 1 dopamine receptor blocking agents (DRBA)s while taking XT, with olanzapine (n=9; 45%) and clozapine (n=6; 30%) being most common. Fourteen patients (70%) discontinued XT during the study time frame due to intolerability (n=9; 45%) and/or lack of effectiveness (n=12; 60%). The average global improvement CGI score was 4 (no change). Gastrointestinal side-effects were most common, specifically, vomiting (n=9; 45%), dyspepsia (n=5; 25%), and sialorrhea (n=5; 25%).

Conclusion: In inpatients with TRS taking adjunct DRBAs (including anticholinergic DRBAs) XT use was commonly discontinued due to intolerability/ineffectiveness. Larger controlled trials are needed to further investigate XT's effectiveness for treating TRS and determine how adjunct anticholinergic use impacts its safety/efficacy.

Introduction: The lack of objective biomarkers and mechanistic understanding of adolescent Major Depressive Disorder (MDD) impedes early diagnosis and targeted intervention.

Methods: To elucidate peripheral molecular biomarkers for adolescent MDD, we performed RNA sequencing on peripheral blood mononuclear cells (PBMCs) from 15 adolescents with MDD and 15 age- and sex-matched healthy controls. Differential expression analysis and protein-protein interaction (PPI) network construction were utilized to identify key regulatory genes. The expression of core targets was validated using RT-qPCR and ELISA. To establish a robust diagnostic model, an integrated feature selection strategy combining Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine-Recursive Feature Elimination (SVM-RFE), and Random Forest algorithms was applied to screen candidate biomarkers.

Results: Transcriptomic profiling identified 367 differentially expressed genes characterized by a dual signature of innate immune activation and compensatory hypoxic responses. Eight core hub genes were identified and experimentally validated, revealing a dichotomous expression pattern: upregulation of erythroid-related and inflammatory factors (SLC4A1, HBB, GYPA, IL6) and downregulation of neurotrophic and remodeling factors (IGF1, CSF2, MMP9, CXCR1). Notably, lower expression levels of MMP9 and CXCR1 were significantly correlated with higher Hamilton Depression Rating Scale (HAMD) scores, indicating greater symptom severity. The multi-algorithm machine learning approach identified a consensus three-gene diagnostic panel comprising SLC4A1, IGF1, and MMP9, which achieved a high classification accuracy with an Area Under the Curve (AUC) of 0.867.

Conclusion: This study delineates a systemic molecular landscape of adolescent MDD defined by the coexistence of hypoxic compensation and neurotrophic/remodeling failure. The identified three-gene biosignature (SLC4A1, IGF1, MMP9) offers a promising, objective tool for the early diagnosis of adolescent depression, highlighting the immune-metabolic interface as a critical avenue for future precision medicine.

Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia and contribute substantially to patient suffering and disability. They are among the most persistent symptoms and do not respond to medication in a substantial portion of patients. Here, we report the application of task-based functional magnetic resonance imaging (fMRI)-guided repetitive transcranial magnetic stimulation (rTMS) in a patient with treatment-resistant AVH. An individualized stimulation target was identified in the left temporal cortex near Heschl's gyrus using a validated fMRI task. Over a period of 18 months, the patient underwent three cycles of inhibitory 1 Hz rTMS of this target. As a result, AVH severity decreased by 33% and the global symptom score improved by 40%. Functional connectivity analyses revealed an increase in coupling between the temporal target seed and a fronto-cingulate-insular network that has been implicated in reality and performance monitoring. This case highlights the potential of fMRI-guided rTMS as a personalized neuromodulatory therapy for refractory AVH in schizophrenia, warranting further systematic investigation.

Introduction: Suicide is a leading global cause of mortality (~800,000 deaths annually) driven by complex biological and environmental determinants; although microRNAs (miRNAs) regulate gene expression implicated in psychiatric disorders, their contributions to suicidality-related phenotypes remain incompletely defined.

Methods: We searched Web of Science, PubMed, Scopus, Embase, and Ovid through July 14, 2025, for human case-control studies comparing individuals with suicidality-related phenotypes to non-suicidal controls. Risk of bias was assessed with the Newcastle-Ottawa Scale. Differentially expressed miRNAs were compiled and analyzed to identify brain-specific gene targets, followed by pathway and disease enrichment.

Results: Of 1,437 records screened, 13 studies met inclusion criteria, encompassing 285 suicidal participants and 291 controls. Across studies, 43 unique miRNAs showed significant differential expression between cases and controls. Three miRNAs-miR-30a, miR-30e, and miR-218-were consistently dysregulated across brain samples from individuals who died by suicide. Bioinformatic analyses indicated that these miRNAs converge on brain-expressed targets and processes relevant to psychiatric biology. Enrichment highlighted pathways involved in transcriptional regulation, forkhead box O (FoxO) signaling, Ras-associated protein-1 (Rap1) signaling, long-term depression, and dopaminergic synapse function.

Conclusion: miR-30a, miR-30e, and miR-218 emerge as recurrently altered miRNAs in suicide and may serve as mechanistic mediators and candidate biomarkers. Mapping their brain-specific targets and enriched pathways suggests actionable avenues for risk stratification and therapeutic development.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD42024582398.

Introduction: Tinnitus is commonly accompanied by emotional distress and sleep disturbances, yet the extent to which these characteristics relate to cochlear electrophysiologic findings remains unclear. This study examined associations between electrophysiologic measures and emotional and sleep parameters in adults with subjective tinnitus.

Methods: This retrospective study included 120 adults with tinnitus. Data collected included demographics, cochlear electrophysiologic measures (electrocochleography and auditory brainstem response), emotional characteristics (perceived stress, depressive symptoms, anxiety, emotion regulation), and sleep parameters (sleep quality, insomnia severity, daytime sleepiness). Correlation analyses and multivariate regression models were applied.

Results: The mean age of the cohort was 62.35 years (SD 9.45), and 64.17% were male. A very weak negative correlation was observed between depressive symptoms and Wave III latency (r = -0.196, P = 0.03), but the small magnitude suggests minimal explanatory value. The summating potential/action potential ratio was not significantly correlated with sleep quality (r = -0.181, P = 0.05). In multivariate models, anxiolytic use was associated with a lower risk of poor sleep (adjusted odds ratio [aOR] = 0.262; 95% confidence interval [CI]: 0.078-0.881; P = 0.030), whereas antidepressant use was associated with a higher risk (aOR = 2.628; 95% CI: 1.027-6.724; P = 0.044). For insomnia, higher pure-tone average thresholds (aOR = 0.948 per dB; 95% CI: 0.906-0.992; P = 0.007) and hearing aid use (aOR = 3.396; 95% CI: 1.085-10.623; P = 0.036) were significant determinants. The only significant factor associated with quality of life was tinnitus duration, with longer duration associated with lower WHOQOL-BREF scores (β = -2.74; P = 0.020). No electrophysiologic parameter demonstrated significant associations in the multivariate models.

Conclusion: Within the constraints of this study, cochlear electrophysiologic measures showed limited observable associations with emotional or sleep characteristics. Factors related to hearing status and medication use demonstrated stronger statistical associations with sleep outcomes, while tinnitus duration was linked to quality-of-life scores. These findings contribute to the growing body of descriptive evidence on tinnitus-related characteristics, although further research with larger cohorts and longitudinal designs is needed to clarify these relationships.

Empathic pain is defined as the experience of vicarious pain resulting from the observation of another person's suffering, and it involves complex neurobiological pathways that parallel those involved in direct pain perception. The intricate link between nonsuicidal self-injury (NSSI) and empathic pain lies in the fact that they share certain neurobiological mechanisms, particularly in the areas of emotion regulation and pain perception, and both phenomena involve brain networks involved in pain processing, emotion regulation, and social cognition. This review examines the current understanding of these mechanisms, including cellular and molecular pathways, changes in neural networks, and factors that influence the development of empathic pain. It also explores potential therapeutic strategies to address the complex interactions between empathic pain and NSSI, focusing on psychological interventions, pharmacological approaches, and novel neurostimulation techniques.

Objectives: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social interaction, communication skills, and repetitive behaviors. However, no effective pharmacological treatments targeting core symptoms have yet been developed. As a non-pharmacological intervention, music therapy (MT) is increasingly being explored for its potential value in improving functional outcomes for children with autism. This study aims to examine the efficacy of MT for children with ASD through a meta-analysis.

Method: We conducted a systematic review following the PRISMA guidelines. A comprehensive and systematic search of PubMed, Web of Science, and the Cochrane Library databases up to August 2025 was performed to identify studies on MT treatment for children with ASD. Continuous variables were reported as standardized mean differences (SMD) with 95% confidence intervals (CI). All analyses were conducted using Stata statistical software version 17.0.

Results: Our meta-analysis included 18 studies. Results showed that MT significantly reduced the total score on the Autism Behavior Checklist (ABC) (SMD = -0.76, 95% CI: -1.31 to -0.22, P = 0.01) and Childhood Autism Rating Scale (CARS) total scores (SMD = -0.43, 95% CI: -0.73 to -0.14, P < 0.01). Specifically, compared with the control group, MT significantly improved social skills (SMD = -0.26, 95% CI: -0.46 to -0.05, P = 0.01), behavioral abilities (SMD = -0.72, 95% CI: -1.06 to -0.39, P < 0.01), and sensory (SMD = -0.87, 95% CI: -1.68 to -0.07, P = 0.03), emotional (SMD = -1.31, 95% CI: -1.98 to -0.64, P < 0.01), and verbal functioning (SMD = -0.65, 95% CI: -0.19 to 1.12, P = 0.01).

Conclusion: In summary, MT demonstrates efficacy in improving behavioral symptoms associated with autism spectrum disorders. However, caution should be exercised when interpreting results due to limited research literature in some analyses. Further studies are needed to validate its therapeutic effects.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251252228.

This meta-analysis aims to estimate the prevalence of posttraumatic stress disorder (PTSD) among the offspring of genocide survivors and examine study-level moderators influencing PTSD rates across cultural settings. Following PRISMA guidelines, seven peer-reviewed studies were identified through systematic searches of major databases, covering genocides in Rwanda, Cambodia, Armenia and Israel (Holocaust). A total of 1,569 participants were included. Data were extracted on sample size, mean age, gender composition, generation, diagnostic assessment tools, and World Bank country classification. A random-effects model was used to estimate pooled prevalence, and meta-regressions assessed the moderating effects of gender composition and mean age. Heterogeneity was evaluated using I² and Q statistics. The pooled probable PTSD prevalence across the seven studies was 17.9% (95% CI: 9.9%-25.8%), which is significantly higher than global population norms during peacetime and not substantially lower than prevalence estimates reported in civilian populations living in war zones. Heterogeneity was substantial (I² = 95.03%, p <.001). Meta-regressions found no significant moderating effect of gender composition or age, possibly due to the limited number of studies with complete data and variations in study methodology. Overall, these findings underscore the persistent impact of genocidal trauma, highlighting how its effects extend beyond directly exposed individuals to shape the mental health of subsequent generations.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251046525.