Frontiers in Psychiatry最新文献

Substantial evidence demonstrates that the brain is more interested in faces than in other subjects and that self-related material, particularly self-images, have higher saliency than non-self-referential material. Studies of self-portraits have revealed correlations between stylistic elements and artists' states of mind. Edvard Munch, a founder of Expressionism and most famous for "The Scream", was pre-occupied with depicting his subjective experience and a prolific painter of self-portraits. He has been posthumously diagnosed as suffering from schizophrenia, anxiety, bipolar and other disorders associated with altered perception. Munch's painted self-portraits were empirically examined to determine if variations in stylistic elements, contrast, colour and fractal dimension, correlate with life events associated with psychopathology. His portraits were also examined as controls and to test whether images of others, related and unrelated to him, vary stylistically from his self-portraits and from each other. Productivity was examined as an independent indicator. Significant changes in contrast, colour, fractal dimension and productivity during critical periods in his life were identified in his self-portraits consistent with the conclusion that Munch is diagnostically best described as suffering from early onset psychosis. Examination of his portraits of related and unrelated people revealed differences from self-portraits and from each other consistent with comorbid social anxiety disorder.

Background: This study assesses the prevalence of psychiatric comorbidities, functioning, and adjustment difficulties of patients undergoing different gender-affirming treatment stages at the centralized Gender Identity Disorder (GID) clinic in Hong Kong.

Method: This cross-sectional study consecutively recruited patients with gender dysphoria according to the DSM-5 criteria in the GID clinic from Oct 2017 to Aug 2018. They were assessed with the Structured Clinical Interview for DSM Axis I disorders (SCID-I) and the Structured Clinical Interview for DSM Axis II personality disorders (SCID-II). Depressive and anxiety symptoms, self-esteem, quality of life and social functioning were measured.

Results: Eighty-nine subjects were recruited. The current and lifetime prevalence of DSM-IV Axis I disorders were 12.4% and 46.1% respectively. Prevalence of personality disorder was 36%. Among the current and lifetime Axis I disorders, depressive disorders were the most common (10.1%, 39.3%). Avoidant personality disorder was the most common Axis II disorder (16.9%). In regression analyses, subjects who received gender-affirming surgery and gender-affirming hormone therapy were associated with better overall (p = 0.034) and psychological domain (p < 0.001) of quality of life and self-esteem (p = 0.033). Gender-affirming hormone therapy alone was associated with better psychological domain (p = 0.001) of quality of life and lower levels of depressive symptoms (p = 0.049). Higher perceived social support was associated with lower levels of depressive symptoms (p < 0.001), better overall (p < 0.001) and psychological domain (p<0.001) of quality of life, and self-esteem (p < 0.001).

Conclusions: Lifetime comorbidity is common in Hong Kong GID Clinic patients with gender dysphoria. Gender-affirming treatments and social support are linked to a better quality of life and self-esteem. Hormone therapy and social support are associated with lower levels of depressive symptoms. Our finding preliminarily suggested better mental health and adjustment in patients with favorable social support who received gender-affirming treatments.

Background: Transgender and gender diverse (TGD) individuals experience elevated rates of emotional distress, often thought to be linked to minority stress, identity-related challenges, and limited access to affirming mental health care. Emotion regulation has emerged as a potential key therapeutic target for improving well-being in this population but less is known about how TGD individuals describe their own needs in relation to psychological treatment.

Aim: This study aimed to qualitatively explore the emotional and psychological needs of TGD individuals, and their experiences of an internet-delivered emotion regulation intervention (I-ER) specifically developed for TGD people.

Method: Ten TGD individuals who had received the I-ER treatment participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis.

Results: Four themes were identified: (1) Emotional Exploration and Self-Understanding, (2) From Emotional Insight to Change, (3) Possibilities for and Limitations in Social Support, and (4) Barriers and Bridges to Treatment Engagement. Participants described the intervention as helpful for emotional insight, identity exploration, and behavioral change. The TGD-specific adaptation fostered a sense of recognition and belonging for most participants. However, challenges related to structure, support access, and individual fit were noted.

Conclusion: Emotion regulation interventions tailored to TGD individuals can be perceived as helpful and supportive when culturally grounded, flexible, and relationally sensitive. Findings highlight the importance of integrating identity-affirming content and addressing diverse support needs in digital mental health programs.

Objective: To examine the demographic and clinical characteristics of patients with intentional drug overdose (IDO) presenting to the emergency department and to identify risk factors associated with repeated IDO, thereby providing an evidence-based foundation for emergency nursing interventions and prevention strategies.

Methods: A retrospective cross-sectional study was conducted using emergency department medical records of 601 patients with intentional drug overdose (IDO) (ICD-10 codes: T36-T50) who presented to a tertiary hospital in Wuhan, China, between January 2023 and December 2024. Demographic characteristics, seasonal distribution, substance categories, psychiatric history, alcohol use, and prior self-harm were collected. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed.

Results: The majority of patients were female (70.4%) and adolescents or young adults aged 10-29 years (72.2%), with a median age of 22 years. Overall, IDO cases demonstrated seasonal peaks in autumn and spring, accounting for 61.6% of presentations. Age-stratified analyses revealed significant seasonal variation (χ² = 27.064, p = 0.008), with adolescents and young adults showing a pronounced autumn peak (both >35%), whereas middle-aged adults (45-59 years) exhibited a relative summer peak. Medication-related poisoning accounted for 96.7% of cases, primarily involving antipsychotics and sedative-hypnotics, while pesticide poisoning comprised 3.3%. A history of prior self-harm was independently associated with repeated IDO (OR = 26.66, 95% CI: 11.17-63.61, p < 0.001). Conclusion: Patients presenting with IDO in the emergency department were predominantly adolescents and young adults, with a higher proportion of females. Overall presentations peaked in autumn and spring, largely driven by younger age groups. A prior history of self-harm was independently associated with repeated IDO. Emergency nurses should routinely assess self-harm history, prioritize early identification and intervention among high-risk adolescents and young adults, and strengthen integrated "emergency-psychiatry-community" care pathways to reduce recurrence.

Introduction: The perinatal period is widely recognized as a time of profound transition and heightened vulnerability, particularly for women with substance use disorders (SUD). Adopting a strengths-based perspective, this qualitative study aims to explore how professionals across healthcare, child welfare, substance use, and child protection services in Belgium perceive this period as a window of opportunity for change in women with SUD.

Method: Semi-structured interviews were conducted with 43 professionals, and thematic analysis identified key themes related to barriers, opportunities, and facilitators to achieve change.

Results: Barriers include disconnected bodily awareness, mutual avoidance between women and professionals, limited insight and (self-) reflection on SUD and motherhood, and insufficient support across interpersonal, socioeconomic, and systemic levels. However, professionals also identified several areas that could be reinforced to unlock the period's transformative potential, reflecting a gradual shift from a deficit-oriented view toward a more strengths-based understanding of perinatal SUD. Empowerment was seen as crucial through open conversations on family planning, psychoeducation on fertility and contraception, access to appropriate contraceptives, and trauma-sensitive, body-oriented approaches that foster connection to pregnancy and the unborn child, as well as the integration of the infant mental health perspective. The perinatal period itself was considered a naturally occurring window of opportunity for change, driven by processes of identity transformation and growing maternal motivation. Professionals emphasized the importance of enhancing professional capacity, particularly in healthcare, and improving screening and referral by midwives and gynecologists. At the care system level, increased and more consistent contact with healthcare services during pregnancy was described as a contextual opportunity for timely support; however, intersectoral collaboration and integrated care were considered essential, alongside a legal prenatal framework that enables early, non-punitive interventions to support both mother and (unborn) child.

Discussion: These findings underscore the need to move beyond hegemonic discourses that frame strength and deficit, mothering and substance use, or vulnerability and opportunity as binary opposites. Recognizing the ways these dimensions coexist and intersect is vital for developing responsive, relational, and ethically grounded models of perinatal care.

Transcranial magnetic stimulation (TMS) has emerged as a promising intervention for cocaine use disorder (CUD). However, a key concern when employing TMS in CUD is the potential risk of seizures. Our goal was to assess seizure risk in individuals with CUD undergoing TMS and to propose parameters that could mitigate it. Our review of the literature indicated that seizures are primarily associated with high-dose cocaine use necessitating urgent medical care - and that the risk is likely low outside of this setting. Thus, to mitigate potential seizure risks during TMS sessions, we suggest an assessment of recent cocaine use and an evaluation for cocaine toxicity. Additionally, rechecking motor threshold levels during treatment with TMS is recommended, especially if patterns of cocaine use change. Previous studies of TMS in CUD reported on two seizures that were linked to recent cocaine use rather than proximity to TMS treatment itself. Future research should document the timing of cocaine use relative to TMS sessions to further ensure the safety of this therapeutic approach.

Background: Orthorexia nervosa refers to a pathological obsession with eating "pure" or "healthy" food, and researchers have emphasized the need for psychometrically sound instruments to assess underlying belief systems rather than behavioral outcomes. The Orthorexia Beliefs Scale (OBS) was developed for this purpose, but no validated Chinese version exists.

Objective: This study aimed to translate and culturally adapt the OBS into Chinese and to evaluate its psychometric properties, including reliability and construct validity, in a Chinese nonclinical sample.

Methods: The original OBS was translated following standard forward-backward translation procedures and refined through expert review and pilot testing. A total of 352 Chinese participants completed the questionnaire, which was randomly split into two subsamples (N₁ = 152 for exploratory factor analysis; N₂ = 200 for confirmatory factor analysis). Item analysis, internal consistency (Cronbach's α, McDonald's ω), content validity (CVI), exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.

Results: Item-total correlations ranged from 0.46 to 0.64. Content validity indices (I-CVI) were high across items, and the scale-level S-CVI/Ave was 0.99. The EFA extracted three factors explaining 50.3% of variance, consistent with the original theoretical structure. CFA results showed acceptable model fit: χ²(167) = 265.66, p <.001, χ²/df = 1.59, CFI = 0.949, TLI = 0.942, RMSEA = 0.053 (90% CI [.041,.065], PCLOSE = 0.328). Cronbach's α and ω were above 0.80 for the total scale and all subscales. Test-retest reliability (n = 30, two-week interval) yielded intraclass correlation coefficients (ICC) above 0.75.

Conclusions: The Chinese version of OBS (OBS-C) demonstrated strong reliability and validity in a nonclinical Chinese sample. It is a psychometrically sound instrument suited for assessing orthorexia-related belief systems in Chinese populations, laying a foundation for future research and interventions on orthorexia tendencies in China.

Background: Premenstrual syndrome (PMS) is a common gynecological problem that can seriously impair the quality of life of women of childbearing age. Substantial evidence confirms the efficacy of external Traditional Chinese Medicine (TCM) therapies for PMS, though the optimal intervention remains uncertain.

Objective: This study aims to compare the efficacy and safety of external TCM therapies for PMS using Bayesian network meta-analysis, thereby informing evidence-based clinical decisions.

Methods: We systematically searched eight databases for randomized controlled trials (RCTs) evaluating various external TCM therapies for PMS, with all searches conducted through March 10, 2025. The primary outcome measures were overall effective rate and symptom severity scores. We used Stata 17.0 to perform network meta-analysis and compare the therapeutic effects of different interventions on improving PMS symptoms.

Results: The screening process identified 21 eligible RCTs involving 1,818 patients. Most studies demonstrated unclear risk of bias due to insufficient selective reporting details, while six studies were rated high risk for inadequate randomization reporting. The NMA results show that in terms of total effective rate, Jianpi-Shugan acupuncture has the highest SUCRA value (95.7), and for symptom and sign scores, ear acupressure ranks first (SUCRA = 71.2).

Conclusion: External treatment methods of traditional Chinese medicine can serve as a complementary or alternative therapy for PMS; Jianpi-Shugan acupuncture can better enhance the overall effective rate in treating PMS, while ear acupressure is more effective in improving symptom and sign scores. Overall, external treatment methods of TCM for PMS are effective and have almost no side effects, but many high-quality studies are still needed to provide more direct evidence.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42025643025.

The delay in medical imaging exams can cause significant anxiety, impacting patient adherence, imaging quality, and overall experience. Intelligent imaging triage systems, driven by artificial intelligence in radiology, aim to improve examination processes and reduce patient anxiety. This review discusses the prevalence of patient anxiety during waiting periods, as well as the physiological and psychological mechanisms. In addition, the structure and functions of these systems, their current use in top domestic hospitals and international healthcare systems, and initial findings on anxiety reduction and enhanced patient satisfaction are analyzed. Some methods were proposed to address the challenges, such as limited evidence, sample representation, and durability assessment. Potential technological advancements, innovations in clinical services, and future interdisciplinary opportunities and policy implications were explored. Intelligent imaging triage systems have the potential to improve the medical workflow efficiency and provide emotional support within patient-centered care. This review concludes that while promising, the widespread adoption of these systems necessitates more robust evidence, interdisciplinary collaboration, and supportive policies.

Introduction: To explore the relationship between the improper promotion of lottery games and the harm caused by lottery players' purchase of lottery tickets, as well as the chain mediating role of the compulsive tendency of lottery purchase addiction, bad lottery purchase behaviors, and responsible lottery purchase beliefs.

Methods: A questionnaire survey was conducted on 600 lottery players, and the data were analyzed using SPSS 27.0 and the PROCESS plugin.

Results: (1) The improper promotion of sports betting is directly related to the harm caused by sports betting; (2) The improper promotion of sports betting is related to the harm through three indirect pathways: namely, through the compulsive tendency of gambling addiction, bad gambling behaviors, and the chain relationship between gambling addiction and bad gambling behaviors as mediating factors; (3) The belief of responsibility when purchasing lottery tickets played a moderating role in the impact of improper sports betting promotion on gambling addiction behavior, which could buffer the impact of improper sports betting promotion on gambling addiction behavior and the impact of problem gambling behavior on the harm of lottery betting. The responsible purchase belief also played a moderating role in the impact of improper lottery betting promotion on gambling addiction behavior, which could buffer the impact of improper lottery betting promotion on gambling addiction behavior and the impact of problem gambling behavior on the harm of lottery betting.

Conclusion: The mediating model constructed in this study to some extent reveals the mechanism of the impact of improper promotion on the harm of sports betting, and provides theoretical support and practical guidance for preventing the risk of harm from sports betting.