Frontiers in Psychiatry最新文献

Background: Converging evidence suggests that bipolar disorder (BD) involves mitochondrial dysfunction and prefrontal cortex (PFC) hypometabolism associated with cognitive impairment, which persists in remitted BD individuals. Transcranial infrared laser stimulation (TILS) provides safe, non-invasive brain stimulation that enhances PFC metabolism via photobiomodulation of mitochondrial respiration and tissue oxygenation. We tested the hypothesis that the neurocognitive deficits found in BD may be ameliorated by TILS treatments.

Methods: This is the first study to explore neurocognitive effects of repeated TILS administration in BD. Using an open-label design, 29 individuals with remitted BD received six weekly TILS treatments. Working memory and attention were assessed with trail-making and 2-back tasks sensitive to TILS cognitive effects in individuals with BD. Changes in PFC network interactions were measured with functional near-infrared spectroscopy (fNIRS) because this method can measure TILS effects on oxygen metabolism in the PFC of individuals with BD.

Results: Participants reported no adverse effects from treatment, confirming the safety of this intervention in individuals with BD. Cognitive test results showed that in people with remitted BD, TILS was effective at improving cognition, i.e., enhanced speed and accuracy in tasks reflecting cognitive flexibility, working memory, and attentional control. Antipsychotic medication improved TILS cognitive effects. The fNIRS results showed a significant reduction in PFC network correlations of oxygenated hemoglobin changes driven by cognitive task performance. The right-hemisphere frontopolar cortex showed greater TILS effects than its left-hemisphere counterpart.

Conclusions: Repeated TILS is a safe intervention to improve cognition in people with remitted BD. Continued antipsychotic medication may have contributed to the cognitive improvement. To confirm TILS efficacy, a sham-controlled, double-blinded randomized trial is needed.

Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05354895.

Introduction: The prevalence of Generalized Anxiety Disorder (GAD) has increased rapidly, highlighting the importance of its detection using quick tools applicable to men and women from different countries.

Objective: To analyze the psychometric properties of the Generalized Anxiety Disorder Test (GAD-7) by gender and country in Latin America and the Caribbean (LAC).

Method: A cross-sectional e-health study with 12,124 participants from 15 LAC countries (54.32% women, 45.68% men) was conducted, including participants from Argentina (7.3%), Bolivia (6.7%), Colombia (10.3%), Chile (6.9%), Costa Rica (4.9%), El Salvador (5.7%), Ecuador (7.2%), Guatemala (4.7%), Panama (5.1%), Paraguay (5.7%), Peru (8.6%), Puerto Rico (5.8%), the Dominican Republic (6.6%), Uruguay (6.3%), and Venezuela (8.2%). All participants completed the GAD-7 scale digitally.

Results: A unidimensional structure of the GAD-7 was confirmed, explaining 70% of the variance. The model fit indices were adequate (RMSEA = 0.062; CFI = 0.997; TLI = 0.995; SRMR = 0.017; p < 0.001), and the factor loadings for each item were satisfactory (> 0.70). Additionally, the factor structure showed measurement invariance between genders and countries, with adequate fit indices at all levels (configural, metric, scalar, and strict), suggesting that the measurements are equivalent in both contexts. Finally, the internal consistency of the GAD-7 was high, with a McDonald's Omega coefficient of 0.91.

Conclusions: The GAD-7 exhibits a factor structure that is equivalent across genders and countries, demonstrating its validity and reliability for the rapid detection of GAD symptoms in different countries within the region.

Background: Cognitive rigidity and working memory impairment are established features of internalizing syndromes. Growing evidence suggests that deficits in affective control -cognitive control in the context of emotion - may underpin elevated emotion-related impulsivity in various psychiatric disorders.

Objective: This study examines two components of affective control (affective flexibility and emotional working memory) as potential neurocognitive processes linking emotion-related impulsivity to internalizing psychopathology.

Method: Undergraduate participants (analysis n = 120) completed the Memory and Affective Flexibility Task (MAFT), a novel behavioral assessment designed to assess hot cognition in affective flexibility and emotional working memory performance, alongside self-report measures of impulsivity and symptoms of internalizing disorders.

Results: Structural equation modeling suggested that less accurate working memory during neutral trials (cool cognition) was associated with more symptoms of internalizing psychopathology. However, effects of hot working memory and affective flexibility were not significantly related to emotion-related impulsivity or psychopathology scores.

Conclusions: Although findings provide no support for the validity of MAFT indices of hot cognition, these results replicate and extend work on the importance of cool working memory and emotion-related impulsivity as correlates of psychopathology.

Background: Adjustment disorder (AD) is common among medically ill patients, yet current evaluation methods do not address the specific characteristics in this population. This study aimed to develop a measurement scale for AD in medically ill patients in Colombia and to find evidence of its validity and reliability.

Methods: This was a scale development and validation study. In the first qualitative phase, items were developed. In the second phase, the content validity of each item was evaluated by patients and clinicians. In the third phase, structural validity, internal consistency, test-retest reliability, criterion validity, and convergent construct validity were assessed. Items were analyzed using a generalized partial credit model within an item response theory framework.

Results: The Adjustment Disorder Scale for Medically Ill Patients (ETAM, for its acronym in Spanish) was developed, comprising 20 items that address the free description of stressful situations in the last 15 days and mental symptoms attributed to them. Evidence of content validity was found. The scale was administered to 512 medically ill patients, revealing a three-dimensional structure: 1) "AD Symptoms", 2) "Impact on Self-Care", and 3) "Impact on Desire to Live". Internal consistency was adequate, with McDonald's omega of 0.95 and Cronbach's alpha between 0.82 and 0.92 for its dimensions. ETAM had high test-retest reliability (intraclass correlation coefficient of 0.98). Criterion validity evidence was obtained with an independent psychiatrist's diagnosis, with an AUROC of 0.99, and convergent validity was consistent with hypotheses of correlation with other instruments with similar constructs. Discrimination and difficulty parameters were calculated for each item.

Conclusion: The ETAM is a scale with evidence of validity and reliability that can be used for the diagnosis of AD in medically ill patients in Colombia.

Introduction: Randomized controlled trials require diverse patient groups to ensure broad applicability of results. However, gender minorities are often not included, which affects the generalizability and equity of healthcare outcomes. Inclusive research must consider the diversity of sex and gender to eliminate inequalities and improve health outcomes.

Methods: A two-stage expert survey was conducted using a self-developed questionnaire in which the constructs of sex, gender, and gender expression were considered. Experts rated the importance and practicality of assessing these concepts in clinical trials and evaluated terms for suitability and comprehension. In addition, existing definitions were refined. Consensus was defined as 70% agreement or disagreement.

Results: 14 out of 17 participating experts agreed on the importance to independently assess sex assigned at birth, and 9 out of 16 emphasized this for gender identity in clinical trials. Sex should be assessed with "Please specify your sex assigned at birth" and the answer categories "female", "male", "intersex". Gender identity should be assessed with "I identify as…" and the answer categories "woman", "man", "nonbinary", "trans woman", "trans man", "genderqueer", "genderfluid", "agender", "two spirit". Assessment of gender expression depends on the research question and may not be relevant for every study.

Discussion: Our findings emphasize inclusivity by providing multiple gender options and improve data accuracy by allowing individuals to accurately report their gender identity. The results emphasize the importance of distinguishing between sex assigned at birth, gender identity, and gender expression in research. This ensures that gender diversity is accurately represented and considered, improving the relevance and inclusivity of clinical trials.

Background: The assessment of clinical prognosis in autoimmune encephalitis: Girona (ACPE-Gi) score is a scale for evaluating the severity in the acute phase of autoimmune encephalitis (AE) and predicting the risk of disability at 3 months, measured by modified Rankin scale (mRS).

Methods: Patients were strictly diagnosed with AE according to the current criteria between 1 January 2009 to 31 March 2023 at the University Hospital Dr. Josep Trueta of Girona, Catalonia, Spain. ACPE-Gi score included 14 items, and every item was scored from 0 to 3, depending on their severity with a sum ranging from 0 to 41.

Results: ACPE-Gi score measured the severity in the acute phase and grouped the patients into three groups: mild (<8; 32%), moderate (8 to 15; 60%), and severe (>15; 8%). We found that the third group had a higher risk of disability compared with the first group (p = 0.035). We identified that the mean initial score was significantly higher in the group of patients who had higher mRS at 3 months compared to that in the group of patients who had a mild to moderate disability level (mRS ≤ 2) at 3 months (p = 0.023). In addition, autonomic symptoms and mental status impairment demonstrated to be independent risk factors to predict disability (p < 0.05).

Conclusions: The ACPE-Gi score seems to be a reliable scale for comprehensively evaluating the severity of AE in the acute phase and predicting the risk of disability at 3 months. Dysautonomia and altered mental status predict a poorer prognosis in patients with AE.

Background: Among various mental disorders, anxiety disorder is commonly reported in HIV-positive individuals. Compared to the general population, people living with HIV/AIDS exhibit a higher prevalence of anxiety, with an estimated figure of 68.2% versus 29% in the general population. However, there is a scarcity of studies on the prevalence and associated factors of anxiety among people living with HIV/AIDS in Ethiopia.

Method: An institution-based cross-sectional study was conducted among 320 participants at Gambella General Hospital. The Beck Anxiety Inventory (BAI) scale, Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and the Alcohol Use Disorder Identification Test (AUDIT) were used to collect the data. Data analysis was performed using SPSS version 25. Bivariate and multivariable logistic regressions were employed to identify independently associated variables, and statistical significance was determined at a p-value <0.05.

Results: Out of a total of 323 samples, 320 respondents completed all items, resulting in a response rate of 99.07%. The results showed that 28.4% (95% CI = 23.2-33.9) of participants had anxiety. Factors such as being aged 25 to 40 years, having seen a counselor, HIV disclosure, alcohol use disorders, and perceived high stigma were significantly associated with anxiety in people living with HIV (PLWH).

Conclusion: In the study area, about two out of every seven people living with HIV/AIDS experienced anxiety symptoms. Factors such as being aged 25 to 40 years, having seen a counselor, HIV disclosure, alcohol use disorders, and perceived high stigma were significantly associated with anxiety in this population. Based on these findings, timely intervention is recommended to enhance the overall well-being and quality of life for people living with HIV (PLWH), leading to better health outcomes, reducing the burden of mental health issues, and supporting more holistic, patient-centered care.

Introduction: This study aimed to investigate the role of TAAR2-9 in sleep/wake regulation, given TAAR1's known involvement in modulating neurotransmitter release and sleep patterns.

Methods: Male TAAR2-9 knockout (KO) and wild-type (WT) mice were compared using baseline sleep/wake patterns, responses to sleep deprivation, effects of TAAR1 agonists, and dopaminergic markers. EEG recordings and tyrosine hydroxylase immunohistochemistry were used for analysis.

Results: KO mice exhibited lower delta and theta power and higher gamma power, with fragmented sleep characterized by 16% more NREM sleep during the dark phase and 23% more REM sleep during the light phase compared to WT mice. High doses of the TAAR1 agonist RO5256390 increased wakefulness and reduced NREM sleep, while both RO5256390 and the partial agonist RO5263397 suppressed REM sleep in KO mice. Elevated tyrosine hydroxylase levels in the ventral tegmental area suggested dopaminergic involvement in these altered sleep patterns.

Discussion: TAAR2-9 modulates sleep/wake states and interacts with TAAR1. These findings highlight the therapeutic potential of targeting TAARs 2-9 in sleep-related neuropsychiatric disorders. Further research is needed to elucidate their roles.

Introduction: Social impairments and repetitive behaviors are at the core symptoms of autism spectrum disorder (ASD). Intranasal administration of the neuropeptide oxytocin (OXT) is a promising treatment. However, there have been inconsistencies in the effects of OXT on social impairments and repetitive behaviors.

Methods: A comprehensive search in PubMed, the Cochrane Library, Embase, and Web of Science was conducted to gather randomized controlled trials (RCTs) on the efficacy of OXT in patients diagnosed with ASD up to 11/06/2024. The core outcomes were social impairments measured by total Social Responsiveness Scale (SRS) scores and repetitive behaviors measured by the Repetitive Behavior Scale (RBS).

Results: This meta-analysis ultimately included 12 RCTs with 498 ASD patients. In an initial analysis, intranasal OXT showed no significant effect on social impairments. For a high dose of 48 IU per day, a beneficial effect on social impairments was found. According to the dose-response meta-analysis, the results indicated that higher doses of OXT might be more effective for social impairments. Depending on repetitive behaviors, the overall analysis showed no significant effect, while the dose over 48 IU per day revealed significant results and the dose-response meta-analysis suggested that higher doses could be more effective for repetitive behaviors.

Discussion: Although these findings show no consistent beneficial effects, the results of the dose-response meta-analysis suggest that high doses of intranasal OXT per day may be more effective in ASD.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42024567213.