Frontiers in Psychiatry最新文献

Introduction: Exposure to potentially morally injurious events (PMIEs) has been found to contribute to mental health difficulties (MHD). However, research on PMIE exposure and its consequences among teachers is scant. In this study, we aimed to narrow this gap by examining the associations between teachers' exposure to PMIEs and measures of depression, anxiety, burnout, and intention to leave the profession. Furthermore, we examined the mediating role of expressions of moral injury (i.e., shame and guilt) in these associations.

Method: A sample of 253 Israeli teachers (186 female, 73%) aged 23-66 (M _age = 44, SD = 10.36) completed validated self-report questionnaires assessing the study variables.

Results: The findings demonstrated that exposure to PMIEs contributed significantly to depression, anxiety, burnout, and intention to leave the profession. Through structural equation model analysis, we found that expressions of moral injury mediated the association between PMIEs and MHD.

Discussion: This study underscores the need to address moral injury among teachers as an essential factor for maintaining their mental health, as well as the overall sustainability of the educational system. Early screening and interventions are needed to identify and treat teachers at risk for MHD stemming from moral injury.

Attention orientation toward positive stimuli may have mood-protective or mood-enhancing effects. Eye-tracking is an increasingly administered method to assess biased attention allocation and maintenance. In the present paper, we point to an underestimated but reliable method of eye-tracking research for measuring positive attentional bias and its temporal dynamics: the free-viewing paradigm. To date, few free-viewing eye-tracking studies have specifically examined positive attentional biases in healthy individuals. Against this background, we summarize findings from clinical and subclinical eye-tracking research using free viewing in healthy control groups. We discuss the observed time courses of positive attentional biases during experimental trials, which vary depending on type and number of presented stimuli, and make recommendations on which experimental conditions appear to be favorable for capturing dynamic time courses of positive attentional biases. We identify various individual difference factors that may influence the magnitude of positive attentional biases and should be considered in future studies. Time course analyses of eye-tracking data offer the opportunity to learn more about the time of onset and extent of increase in attention to positive information during free viewing and their relationships to individual difference variables. Directions for future research on positive attentional biases are discussed.

Introduction: The subjective effects of psilocybin on obsessive-compulsive disorder (OCD) are under-explored. Therefore, we conducted a qualitative study of participant experiences from the first randomized placebo-controlled trial of single-dose psilocybin combined with unstructured and non-directive support for individuals with treatment-refractory OCD. Our research explored how participants experienced acute and post-dosing effects, the interrelationships between these effects, and participants' perspectives on therapeutic change.

Materials and methods: We conducted qualitative interviews with 12 participants approximately one month after psilocybin dosing; (six who received psilocybin in the initial randomized placebo-controlled phase, six who received open-label psilocybin following unblinding). We analyzed interview transcripts via interpretative phenomenological analysis (IPA) and engaged in consensus decision-making to arrive at 100% intercoder agreement in the process of abstracting codes into higher-order themes.

Results: Four major themes (and several subthemes) emerged from our analysis: 1) Influences on Psilocybin Experience (i.e., Set, Setting); 2) Acute Effects (i.e., Acute perceptual effects, Acute [meta]cognitive effects, Acute emotional effects, Acute impact of OCD, Other acute effects); 3) Post-Dosing Changes in OCD (i.e., Post-dosing changes in symptoms, Post-dosing changes in perceptions of OCD); as well as 4) Post-Dosing Changes Beyond OCD Symptoms (i.e., Post-dosing [meta]cognitive changes, Other post-dosing changes). Meaningful interrelationships among codes, subthemes, and themes were the norm.

Discussion: Our findings highlight the moderate to strong influences of set and setting in the nature and trajectory of participants' psilocybin experiences. We also uncovered acute, synergistic visual/perceptual, emotional/psychological, and physiological/somatic effects that map onto those commonly reported in prior psilocybin trials for other closely related indications. However, these acute effects tended to occur at lower intensities (i.e., 'partial' experiences) potentially due to acute interference by OCD symptoms. Certain acute and post-dosing (meta)cognitive and behavioral effects also map onto putative mechanisms of action in evidence-based psychotherapy for OCD (e.g., exposure and response prevention [ERP] and acceptance and commitment therapy [ACT]). These findings yielded hypotheses for future investigation, and point toward potential integration of psilocybin with structured psychotherapy approaches for OCD.

Background: Childhood maltreatment has been consistently associated with nonsuicidal self-injury (NSSI). Patients with bipolar disorder (BD) are especially vulnerable to early adversity and self-injurious behaviors; however, the mechanisms underlying this association remain unclear. Among Chinese patients with BD, this study tested whether dysfunctional attitudes mediate the association between childhood maltreatment and NSSI and whether social support moderates this association.

Methods: A cross-sectional study was conducted with 838 clinically diagnosed bipolar disorder patients (68.1% female; median age = 16 years). Measures included the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Dysfunctional Attitudes Scale (DAS-A), Social Support Rating Scale (SSRS), Ottawa Self-Injury Inventory-Chinese Revised Edition (OSIC), and Hamilton Depression Rating Scale (HAMD-24). Descriptive analyses, correlations, mediation, and moderated mediation models were tested using SPSS 26.0 and Mplus 8.3, with robust maximum likelihood estimation (MLR) and 5,000 bootstrap resamples.

Results: In our clinical sample of patients with bipolar disorder, 68.5% reported nonsuicidal self-injury (NSSI). Childhood maltreatment was positively associated with both dysfunctional attitudes and NSSI. Mediation analysis demonstrated that dysfunctional attitudes partially mediated the association between childhood maltreatment and NSSI (indirect effect β = 0.040, 95% CI [0.017, 0.061], p < 0.01), accounting for 18.2% of the total effect. Moderation analysis further indicated that social support significantly attenuated the association between dysfunctional attitudes and NSSI (interaction β = -0.082, 95% CI [-0.162, -0.015], p < 0.05), but did not moderate the associations of childhood maltreatment with either dysfunctional attitudes or NSSI.

Conclusion: Childhood maltreatment increases the risk of NSSI in patients with BD both directly and indirectly through dysfunctional attitudes, while social support mitigates the behavioral impact of dysfunctional attitudes on NSSI. These findings highlight dysfunctional attitudes as a cognitive mechanism and social support as a conditional protective factor, underscoring the importance of childhood maltreatment screening, cognitive restructuring, and support-enhancing interventions in reducing NSSI risk among Chinese patients with bipolar disorder.

Accumulating evidence indicates that circadian rhythm dysfunction is a clinically significant and highly prevalent phenotype in a substantial subgroup of individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). This perspective synthesizes convergent lines of evidence demonstrating strong associations between ADHD and evening chronotype with phase-delayed biological markers. Sleep disturbances are profound: insomnia and sleep disturbances affect up to 80% of adults with ADHD and similarly up to 82% of children with ADHD, delayed sleep-wake timing occurs in up to 78%, and dim-light melatonin onset (DLMO) is delayed by approximately 45 minutes in children and 90 minutes in adults. These alterations coincide with blunted and delayed cortisol rhythms, reduced pineal volume, and attenuated peripheral clock-gene rhythms (BMAL1/PER2). Intervention studies demonstrate that the circadian phase can be successfully advanced in ADHD populations. Melatonin and bright light therapy has advanced DLMO in both children and adults with ADHD. Emerging data correlate phase advancement with ADHD symptom improvement, and winter trials suggest circadian preference shifts best predict symptom improvement. Sleep programs improve ADHD symptoms, sleep quality, and functioning in children. Exercise and multimodal protocols for evening chronotypes successfully advance circadian timing in non-ADHD populations and warrant investigation in ADHD. Based on this evidence, we propose a pragmatic, behavioral-first clinical pathway: routine screening for sleep/circadian disturbances; phenotypic characterization through chronotype assessment, sleep tracking, and DLMO when feasible; implementation of fixed wake times, morning bright light exposure, evening light restriction with screen hygiene, and regularized zeitgebers; and selective low-dose melatonin for confirmed or probable DLMO delays.

Introduction: Despite a relatively short history in the field of disorders, treatment evidence for gaming disorder (GD) and internet addiction (IA) has been gathered. Notwithstanding, in many countries, an understanding of treatment service delivery is lacking. In this study, we have investigated how treatment services at specialist facilities have evolved in Japan, historically and up to the current time, focusing on service delivery and treatment challenges at these facilities.

Methods: We firstly identified facilities providing specialist treatment for GD and IA using mailed questionnaire surveys, with the assistance of mental health and welfare centers, in 2016, 2018, 2020 and 2023. In order to elucidate how treatment was delivered, together with the related treatment difficulties, additional questionnaire surveys were conducted in 2020 and 2023 with specialist treatment facilities, as identified by the aforementioned surveys.

Results: The number of facilities showed a 4.5-fold increase between 2016 and 2023. The service delivery was initiated, maintained, and led by facilities in response to treatment and consultation demand. Despite this increase in number, the geographical distribution has been uneven. With regard to treatment goals, the vast majority of facilities have focused on encouraging activities other than gaming rather than simply reducing gaming time. Notably, between 2020 and 2023, there was a tendency away from generalized and toward specialized treatment programs. Additionally, specialists faced a range of difficulties in treatment delivery, often related to the high comorbidity rate of neurodevelopmental disorders. However, during this period, specialists became increasingly adept at managing these issues.

Discussion: The results suggested that the service delivery system for GD and IA has rapidly developed, driven by treatment facilities in response to growing treatment and consultation demand, which may be characteristic of, or even unique to Japan. The results also suggested that specialization of treatment programs and the skills of specialists in managing difficulties in the course of treatment may have advanced in a relatively brief period of time. Challenges to be addressed include a widening gap between the numbers of treatment seekers and the capacity of treatment providers, together with the skewed geographical distribution of facilities.

Background: Preoperative insomnia is prevalent among elderly arthroplasty patients, yet its impact on postoperative sleep disturbance (PSD) remains underexplored. This study investigated whether preexisting insomnia exacerbates postoperative sleep fragmentation in total hip/knee arthroplasty (THA/TKA) patients under spinal anesthesia.

Methods: In this prospective cohort study 121 patients aged ≥65 undergoing THA/TKA were stratified by preoperative insomnia. Sleep was assessed via subjective metrics including Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS) and Insomnia Severity Index (ISI). Meanwhile, the EEG-based monitor and actigraphy were used to assess the objective sleep quality and conduct sleep staging.

Results: Pre-existing insomnia exacerbates postoperative sleep fragmentation, manifested by persistently elevated microarousals (operative night to postoperation day2, POD2) and prolonged sleep latency. Selective REM suppression occurs in insomnia patients during the acute postoperative phase (operative night and POD1), independent of NREM duration alterations. Subjective sleep quality assessments revealed that the insomnia group demonstrated significantly higher AIS and ISI scores compared to the non-insomnia group.

Conclusion: Preoperative insomnia independently exacerbates postoperative sleep fragmentation in elderly arthroplasty patients. The study was registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085184) on June 8, 2024.

Background: Various brain regions are implicated in fear responses to specific stimuli. While prior research has explored neural connectivity related to fear during COVID-19, gaps remain regarding the specific role of pre-pandemic brain structure in COVID-19-related fear and its impact on long-term psychological problems. This prospective longitudinal study aimed to explore the neural structural basis of individual differences in fear of COVID-19 during the peak of the COVID-19 outbreak in Chinese communities, as well as the neurobehavioral mechanisms by which this fear increased individual PTSD symptoms and general distress one year later.

Methods: Preceding the COVID-19 outbreak, 115 university students from Chengdu, China, were recruited and underwent 3.0T magnetic resonance imaging scans to collect brain structural data. During the peak of the COVID-19 community outbreak, participants' fear was assessed using the Fear of COVID-19 Scale. One year later, long-term post-traumatic stress disorder (PTSD) symptoms and general distress were measured. Associations between Pre-Pandemic Brain Structure, COVID-19 Fear, Posttraumatic Stress and General Distress were examined using Structural equation model.

Results: Whole-brain multiple regression analysis identified that baseline gray matter volume (GMV) in the left (r=0.42, p<0.001) and right insulae (r=0.39, p<0.001) was positively associated with the fear of COVID-19, after adjusting for sex, age, and total GMV. Mediation analysis revealed that this fear mediated the impact of bilateral insular GMV on PTSD symptoms and general distress one year later.

Conclusions: The baseline bilateral insular GMV played a pivotal role in driving the level of fear during the peak of community outbreaks of COVID-19. Additionally, fear served as a crucial mediating factor influencing the association between insular and future psychological problems. These findings could aid in identifying vulnerable populations susceptible to fear during infectious disease outbreaks like COVID-19 and provide insights into identifying target areas for mental health interventions at different stages of future outbreaks.

[This corrects the article DOI: 10.3389/fpsyt.2025.1718106.].