Frontiers in Psychiatry最新文献

Background: Mental health service users are more likely to smoke tobacco and are as likely to make quit attempts as people not experiencing SMI, but they are less likely to succeed. Quitting tobacco can be harder for people experiencing SMI due to higher levels of nicotine dependence, more severe withdrawal, and many other complex factors. The Quitlink study was a randomized controlled trial combining a tailored 8-week Quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy for people who experience SMI. The purpose of this paper is to report on the medium- and longer-term findings from interviews conducted at 5 and 8 months.

Methods: As a part of the broader Quitlink study, participants were invited to qualitative interviews at 2, 5 and 8 months following recruitment, in line with quantitative follow-up time points. Interviews were conducted with 28 participants in the Quitlink trial (intervention group n = 12, control group n = 16). Interviews were transcribed and analyzed with a thematic analysis methodology using NVivo 12. Key themes were determined using inductive coding.

Results: Six key themes were identified. These included: internal/external attributions for tobacco smoking, social relationships and relapse, the role of hopefulness in quitting, the role of clinicians in initiating and maintaining a quit attempt, increasing cessation literacy, and efficacy of the study intervention. Overall, findings suggested that participants' quit attempts were often precarious and vulnerable, but active support and feelings of social connectedness were key to supporting participants to initiate a quit attempt and maintain gains.

Conclusions: People who experience SMI can make attempts to quit smoking tobacco with support from clinicians and social networks. Connectedness and hope are significant enablers of making and sustaining quit attempts.

Trial registration: The Quitlink trial was registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.

Recent technological advances in intracranial brain stimulation have enhanced the potential of neuromodulation for addressing neuropsychiatric disorders. We present a review of the methodology and the preliminary outcomes of the pioneering studies exploring intracranial biomarker detection and closed-loop neuromodulation to modulate high-symptom severity states in neuropsychiatric disorders. We searched PubMed, Scopus, Web of Science, Embase, and PsycINFO/PsycNet, followed by the reference and citation lists of retrieved articles. This search strategy yielded a total of 583 articles, of which 5 articles met the inclusion criteria, focusing on depression, obsessive-compulsive disorder, post-traumatic stress disorder, and binge eating disorder. We discuss the methodology of biomarker identification, the biomarkers identified, and the preliminary treatment outcomes for closed-loop neuromodulation. Successful biomarker identification hinges on investigating across various setting. Targeted neuromodulation, either directed at the biomarker or within its associated neural network, offers a promising treatment approach. Future research should seek to understand the mechanisms underlying the effects of neuromodulation as well as the long-term viability of these treatment effects across different neuropsychiatric conditions.

The COVID-19 pandemic has brought significant challenges, including severe psychological consequences, especially for vulnerable individuals, such as those with substance use disorders. This study investigated the impact of the pandemic on substance use patterns and psychological health in Brazilians, exploring associations with sociodemographic factors to identify groups at higher risk. Data were collected online to assess self-reported substance use through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and psychological state, using the Depression, Anxiety and Stress Scale (DASS-21) and level of social distancing. The research was conducted in three waves: September-October 2020, April-May 2021, and September-November 2022. The ASSIST (alcohol, cannabis, hallucinogens, and cocaine/crack) and DASS-21 (anxiety, depression, and stress) scores decreased over time. Regarding sociodemographic data, being male, single, with less education, lower income and lower social distancing showed associations with alcohol and cannabis scores. All drug scores showed associations with psychological symptoms and time, suggesting a possible adaptation or resilience of the sample to the challenges of the pandemic. These findings highlight the importance of monitoring patterns of substance use and mental health in times of crisis, especially in vulnerable populations. Such knowledge is essential to inform public health strategies and prepare health systems to face future global crises.

Background: Clinical studies have not conclusively clarified whether fatigue scores in living kidney donors after donation are fundamentally different from general population samples. Moreover, the association between sociodemographic and donor specific factors and fatigue in donors is not well understood.

Patients and methods: Fatigue scores of 358 living kidney donors on average 7.67 years post-donation were compared with 1896 subjects from the German general population in five strata of age and sex. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20). Relationships between the five MFI-20 subscales and the sociodemographic variables sex, age, education, and in the donor sample also years since donation were calculated. Additionally, the association between donor specific variables and fatigue levels were analyzed.

Results: Overall, donors had lower fatigue scores than the population sample. Particularly the age group 65-74 and above reported significantly lower fatigue scores. A significant exception was found in women aged 45-54 years, where donors showed significant higher general fatigue scores than the corresponding subgroup of the general population sample. Multiple regression analyses in the general population sample revealed associations between female sex and higher age with higher values in most MFI-20 subscales, whereas subjects with higher education showed mostly lower fatigue scores. In the donor group, these associations were of little importance. Also, years since donation, partnership, and recipient group were not strongly related to fatigue. However, higher fatigue in donors was associated with more donation regret, a more negative relationship with the recipient, a more negatively perceived recipient health, less perceived family support, and more financial burden.

Conclusion: Fatigue is less prevalent particularly in older donors and predictors of fatigue presented in the general population sample seem to have little importance in the donors. However, middle-aged female donors might be more prone to develop fatigue. This group may require more intense exploration before and after donation to detect and treat the underlying factors timely.

Introduction: Premonitory urges are uncomfortable bodily sensations preceding tics. They are highly prevalent, frequently bothersome, and increasingly recognized as a central phenotypic feature in tic disorder populations. This scoping review aimed to systematically consolidate published knowledge and identify knowledge gaps regarding premonitory urges in primary tic disorders.

Methods: Search strategies were deployed in five databases and five topic-relevant journals. Two independent reviewers screened all candidate abstracts against predefined inclusion criteria. One hundred and fifty-five articles were included in the scoping review. The same two reviewers independently extracted and consolidated pertinent data from included articles.

Results: Multiple methods for assessing premonitory urge were identified, each with strengths and weaknesses. The subjective quality of premonitory urges varies between individuals, with increased prevalence of a "not just right" urge quality in individuals with comorbid obsessive-compulsive disorder. Awareness of premonitory urge appears to arise several years after tic-onset, yet many individuals perceive their tics as voluntary responses to premonitory urges. Premonitory urges and tics are temporally coupled in real time, but premonitory urge severity and tic severity, as assessed by clinical scales, are not consistently associated. The mechanistic and developmental relationship between premonitory urges and tics remains unclear. Data are limited on premonitory urge response to treatment, but several promising interventions were identified. The insula and supplementary motor area are the neuroanatomical structures most strongly implicated in emergence of the premonitory urge.

Discussion: Knowledge of the clinical characteristics, measurement, and neural mechanisms of premonitory urge has advanced considerably in recent years, but important knowledge gaps remain in each of these domains. Addressing these knowledge gaps will be key to developing effective interventions for premonitory urge.

Systematic review registration: Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/WT43Z.

Background: In Pakistan, the mental health care for persons living with disabilities is insufficient, lacking a holistic approach to address their needs. This research evaluates the adapted PM+'s (IA-PM+) initial efficacy and acceptability in improving mental health among persons living with disabilities, contributing to the integration of mental health services within primary care settings in Pakistan.

Methods: This study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention's effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention's acceptability among the participants.

Results: The study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen's d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522.

Introduction: Batterer impulsivity and substance use are relevant factors in the study of gender violence. Impulsivity is defined by the tendency to act suddenly and without forethought. Combined with drunkenness, it can materially increase the likelihood of intimate partner violence.

Methods: The present study examines substance use and impulsivity among a sample of 243 men convicted of IPVAW offences under the Spanish Gender Violence Act (Organic Law 1/2004) in relation to the levels of violence and psychopathologies presented by these perpetrators, in order to understand the results of court-ordered psychological treatments provided under Spain's Gender Violence Offenders Intervention Program. The participants, aged an average 39.1 years, were classified into three types based on demographic factors, substance use and other relevant variables. Meanwhile, the tools used included AUDIT and EuropASI to assess alcohol consumption, CTS2 to measure the frequency and intensity of violent behaviors over the last year, and SCID-II for personality disorders.

Results: Our findings reflected marked improvements in conflict resolution strategies, especially in terms of reduced psychological violence and sexual coercion, but not physical violence. Impulsivity and early-onset alcohol use were identified as key risk factors for violent behavior. Latent class analysis revealed the existence of three sub-types, comprising high-risk batterers displaying high levels of aggression and drinking problems, low-risk batterers displaying high levels of secondary psychopathy, and medium-risk batterers.

Discussion: The study underscores the need for differentiated treatment approaches to address both psychological problems and substance use, while highlighting the need for personalized interventions to rein in violent behavior and prevent reoffending. We We propose a future longitudinal study to throw light on the subsequent developmental paths taken by IPVAW offenders.

Background: Learning from feedback - adapting behavior based on reinforcing and punishing outcomes - has been implicated in numerous psychiatric disorders, including substance misuse, post-traumatic stress disorder, and depression; an emerging literature suggests it may also play a role in suicidality. This study examined whether a feedback-based learning task with rewarding, punishing and ambiguous outcomes, followed by computational modeling, could improve near-term prospective prediction of suicide attempt in a high-risk sample.

Method: Veterans (N=60) at high-risk for suicide were tested on a task of reward- and punishment-based learning, at multiple sessions across a one-year period. Each session was coded according to whether the participant had (1) an actual suicide attempt (ASA); (2) another suicide-related event (OtherSE) such as suicidal behavior or suicidal ideation-related hospital admission (but not an ASA); or (3) neither (noSE) in the next 90 days. Computational modeling was used to estimate latent cognitive variables including learning rates from positive and negative outcomes, and the subjective value of ambiguous feedback.

Results: Optimal responding on the reward-based trials was positively associated with upcoming ASA, and remained predictive even after controlling for other standard clinical variables such as current suicidal ideation severity and prior suicide attempts. Computational modeling revealed that patients with upcoming ASA tended to view ambiguous outcomes as similar to weak punishment, while OtherSE and noSE both tended to view the ambiguous outcome as similar to weak reward. Differences in the reinforcement value of the neutral outcome remained predictive for ASA even after controlling for current suicidal ideation and prior suicide attempts.

Conclusion: A reinforcement learning task with ambiguous neutral outcomes may provide a useful tool to help predict near-term risk of ASA in at-risk patients. While most individuals interpret ambiguous feedback as mildly reinforcing (a "glass half full" interpretation), those with upcoming ASA tend to view it as mildly punishing (a "glass half empty" interpretation). While the current results are based on a very small sample with relatively few ASA events, and require replication in a larger sample, they provide support for the role of negative biases in feedback-based learning in the cognitive profile of suicide risk.

Opioid dependence is a serious, life-threatening condition with severe social impacts. Naltrexone (NTX) can weaken the effect of opioids and effectively reduce opioid self-administration, discrimination, and opioid-induced subjective effects, and the oral dosage form has been approved for the treatment of opioid dependence. However, the effectiveness of oral naltrexone as an opioid antagonist has been limited due to poor patient adherence. A long-acting formulation in the form of naltrexone implant (NTX-IMP) with a five-month duration of action may address this issue and improve outcomes. This study (trial registration number: CTR20181954) aimed to evaluate the effect, safety, and pharmacokinetics of NTX-IMP in agonist effects via hydromorphone challenge test, and to determine optimal dosages for future research. Thirty-one former opioid-dependent individuals were randomized to the 0.9g or the 1.5g NTX-IMP group. All subjects exhibited significant antagonistic effects during hydromorphone challenge test. Calculation of slope between VAS score or pupil diameter and hydromorphone dose suggested a stronger antagonistic effect in the 1.5 g group. Pharmacokinetic data suggested that effective plasma naltrexone concentration (≥1ng/ml) was detected from the third day for over 148 days, with higher concentration and longer duration in the 1.5 g group. All subjects tolerated NTX-IMP well. The findings indicate that the NXT-IMP effectively blocks the agonistic effects of hydromorphone in a dose-dependent manner.

Background: Increasing evidences suggests that depression is a heterogeneous clinical syndrome. Cognitive deficits in depression are associated with poor psychosocial functioning and worse response to conventional antidepressants. However, a consistent profile of neurocognitive abnormalities in depression remains unclear.

Objective: We used data-driven parsing of cognitive performance to reveal subgroups present across depressed individuals and then investigate the change pattern of cognitive subgroups across the course in follow-up.

Method: We assessed cognition in 163 patients with depression using The Chinese Brief Cognitive Test(C-BCT) and the scores were compared with those of 196 healthy controls (HCs). 58 patients were reassessed after 8 weeks. We used K-means cluster analysis to identify cognitive subgroups, and compared clinical variables among these subgroups. A linear mixed-effects model, incorporating time and group (with interaction term: time × group) as fixed effects, was used to assess cognitive changes over time. Stepwise logistic regression analysis was conducted to identify risk factors associated with these subgroups.

Results: Two distinct neurocognitive subgroups were identified: (1) a cognitive-impaired subgroup with global impairment across all domains assessed by the C-BCT, and (2) a cognitive-preserved subgroup, exhibited intact cognitive function, with performance well within the healthy range. The cognitive-impaired subgroup presented with more severe baseline symptoms, including depressed mood, guilt, suicidality, and poorer work performance. Significant group × time interactions were observed in the Trail Making Test Part A (TMT-A) and Continuous Performance Test (CPT), but not in Symbol Coding or Digit Span tests. Despite partial improvement in TMT-A and CPT tests, the cognitive-impaired subgroup's scores remained lower than those of the cognitive-preserved subgroup across all tests at the study endpoint. Multiple regression analysis indicated that longer illness duration, lower educational levels, and antipsychotic medication use may be risk factors for cognitive impairment.

Conclusion: This study identifies distinguishable cognitive subgroups in acute depression, thereby confirming the presence of cognitive heterogeneity. The cognitive-impaired subgroup exhibits distinct symptoms and persistent cognitive deficits even after treatment. Screening for cognitive dysfunction may facilitate more targeted interventions.

Clinical trial registration: https://www.chictr.org, identifier ChiCTR2400092796.