International Journal of Psychiatry in Clinical Practice最新文献

Introduction: Many studies have reported that psychiatric disorders may be associated with oxytocin receptor (OXTR) gene polymorphisms. The aim of this study was to investigate whether there is a relationship between OXTR gene polymorphisms and bipolar disorder (BPD).

Methods: The study included 100 patients diagnosed with BPD type 1 (BPD I) and 96 healthy controls. Single nucleotide polymorphisms (SNPs) of the OXTR gene, including rs53576, rs2254298 and rs2268494, were examined via polymerase chain reaction in blood samples taken from the study participants. Based on the BPD determinants, the patients were divided into 4 subgroups, as those with psychotic features, seasonal patterns, rapid cycling and peripartum onset.

Results: The frequency of the rs2268494 A allele was lower in the patients than in the healthy controls (p = .048), that frequency of psychotic mania was higher in patients with the rs53576 GG genotype compared to the A allele carriers (p = .003), and that of the seasonal pattern was higher in those carrying the rs2268494 A allele compared to those carrying the rs2268494 TT genotype (p < .001).

Conclusion: OXTR gene polymorphisms may be associated with several clinical determinants of BPD. Multicentre studies involving more subjects are required to verify these findings.

Objective: Sex differences have been suggested in both schizophrenia (SCZ) and autism spectrum disorder (ASD). This study aims to assess the prevalence and clinical correlates of autistic features in male and female patients with chronic SCZ.

Methods: A total of 1690 chronic SCZ patients (M/F: 1122/568) were recruited from ten psychiatric hospitals in China. The Positive and Negative Syndrome Scale Autism Severity Score and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were utilised to assess the presence of autistic features and measure cognitive function, respectively.

Results: Female SCZ patients had a higher prevalence of autistic features than male SCZ patients. In male patients, those with autistic features exhibited higher illness duration and RBANS scores, but lower years of education. Whereas in female patients, those with autistic features had higher RBANS scores, but lower years of education. Binary logistic regression analysis revealed that years of education, illness duration, visuospatial/constructional abilities, and language were correlated with autistic features in male patients. In female patients, years of education, language, and delayed memory were correlated with the presence of autistic features.

Conclusions: Our findings suggest that sex differences exist in the prevalence and clinical correlates of autistic features in chronic SCZ patients.

Objective: Efficacy and safety of transcranial direct current stimulation (tDCS) in the treatment of obsessive-compulsive disorder (OCD) were explored by meta-analysis.

Method: Four electronic databases (Cochrane, PubMed, Embase, Web of Science) were retrieved at 25/06/23. From our inclusion criteria, seven studies (N = 201 patients) were included, and we performed a meta-analysis using Stata15.0.

Results: Results suggested that the total Y-BOCS (Yale-Brown obsessive com-pulsive scale) scale was significantly lower in patients with OCD after tDCS treatment [SMD= -0.46, 95%CI (-0.84, -0.07), I²=39%, p = 0.02, Grade: high]. Subgroup analysis showed statistically significant results when treatment duration ≤ 20 days [SMD= -0.95, 95%CI (-1.80, -0.10), p = 0.03]. Moreover, tDCS and sham tDCS-treated OCD patients showed neither significantly different depressive symptoms nor significantly different adverse events [RR= -0.21, 95%CI (-0.58, 0.15), p = 0.25, Grade: moderate] and [RR = 3.98, 95%CI (0.04, 374.99), p = 0.55, Grade: very low], respectively.

Conclusion: tDCS maybe reduce the Y-BOCS total scores in OCD patients and depressive symptoms, but for adverse reactions. the results are inconclusive.

Objectives: Research on new serum parameters in bipolar disorder (BD) and schizophrenia is crucial for early diagnosis and understanding of disease pathophysiology. The arginine metabolic pathway has been found to be associated with several neuropsychiatric disorders in recent years. This study aims to investigate the role of serum markers involved in different steps of the arginine metabolic pathway in BD and schizophrenia.

Methods: Sixty healthy volunteers, sixty patients with schizophrenia and sixty patients with BD were included in the study. We analysed ornithine decarboxylase (ODC), arginine decarboxylase (ADC) and agmatinase levels using enzyme-linked immunosorbent assay. Enzymatic colorimetric methods were used for nitric oxide (NO), nitric oxide synthase (NOS) and arginase measurement.

Results: Serum agmatinase levels were significantly lower in BD and schizophrenia (p < 0.01). ODC and ADC levels were significantly lower in BD group compared to the control and schizophrenia groups (p < 0.001; p < 0.01). Serum NO levels were significantly higher and NOS levels were significantly lower in BD (p < 0.001; p < 0.05). Arginase levels were also lower in BD (p < 0.05).

Conclusions: Enzymes and substrates of the arginine metabolic pathway are promising markers in BD and schizophrenia. These markers can also be used to enable the diagnosis, when an adequate verbal communication is impossible.

Objective: Intensive Home Treatment (IHT) is an alternative to acute inward treatment. The objective of this study was to assess which variables predict that a patient admitted to IHT required transfer to hospital for inward management.

Methods: We included the first 1000 episodes admitted to IHT and looked for crude associations between potential predictive factors and transfer to hospital. Then, we built a predictive model for this outcome.

Results: The patients with a higher risk of transfer to hospital were those who had previous hospitalisations (OR = 2.6; 95% CI = 1.4-4.7), more admissions in the previous 5 years (median= 0, IQR = 0-1 vs. median = 0, IQR = 0-1.5; p = 0.0011) and a higher clinical severity at IHT admission (mean difference = 0.36; p50 = 0, IQR = 0-1.5 vs. p50 = 0, IQR = 0-1; p = 0.0011). The predictive model included age, previous admissions, clinical severity at IHT admission, and substance use at the beginning of the episode but had a low performance (R2 = 0.115; AUC = 0.752, 95% CI: 0.690-0.814).

Conclusion: Our results are consistent with those from previous studies in countries with different mental health systems. Far from cautioning us against using IHT in patients with severe symptoms or previous hospitalisations, these results should encourage us to find ways to offer them greater support at home.

Modern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in depressed patients showing non-response to two or more trials of antidepressants. Recently, large sample head-to-head comparisons of intravenous ketamine versus ECT for treatment-resistant depression (TRD) have fuelled the debate on which therapy might be more effective. However, the informative value of these studies is limited due to major methodological differences, especially regarding patients' baseline clinical characteristics and treatment procedures. This commentary, in reaction to the recently published article by Jha et al. 'Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial' in JAMA Network Open, addresses this issue and proposes that treatment decisions of ECT or ketamine should be based on substantiated, predictive clinical response markers and patient's preferences. It is undisputed that both treatments are highly effective in TRD, yet, given that ketamine is usually administered before ECT, efficacy studies of ECT in ketamine non-responders are urgently warranted.KEYPOINTSModern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in treatment-resistant depressionHead-to-head comparisons of both treatments have yielded incongruent findings due to differing patients' baseline clinical characteristics and treatment proceduresTreatment-decisions of ECT or ketamine should be based on predictive clinical response markers and patient's preferences while considering the specific side effect profiles of both optionsFuture prospective studies should assess the efficacy of ECT in ketamine non-responders.

Objective: The first-episode psychosis (FEP) and clinical high-risk (CHR) team within the child and adolescent mental health (CAMH) service receives referrals by psychiatric units, CAMH service, schools, and general practitioners. This audit evaluated the implementation of the FEP-CHR team in Ferrara, Italy.

Methods: The FEP-CHR team provides standardised assessment and up to 2-year individualised treatment including pharmacological prescription, cognitive-behavioral psychotherapy, and vocational activities. Data regarding access and pathways to care, assessment, and outcome of all patients admitted to this service from January 2019 to June 2023 were analysed. Descriptive statistics were reported and discussed.

Results: The service admitted 29 patients (19 FEP, 10 CHR), mostly females. FEP referrals primarily came from families via general practitioners, while half of CHR patients were already receiving CAMH care. One in three in the total sample had psychiatric hospitalisation during treatment. At discharge, most transitioned to usual or specialised mental health care and five patients achieved full recovery.

Conclusions: The audit revealed a lower-than-expected incidence rate, a sub-optimal adherence to the standardised assessment, and a need for improved outcome monitoring. It promoted quality improvement initiatives including professional training to improve psychiatric differential diagnosis, drug prescribing, and transition to adult psychiatric services.

Introduction: The controversy of antidepressant use in bipolar depression remains controversial. Agomelatine (AGO) is an effective antidepressant in major depressive disorder (MDD), but its application in bipolar depression was little discussed. We aimed to provide a comprehensive systematic review of clinical evidence from studies examining the efficacy and safety of AGO for bipolar depression.

Methods: We conducted a systematic review about AGO trials for the treatment of bipolar patients. We searched PubMed, MEDLINE, Embase, and Cochrane for relevant studies published since each database's inception. We synthesised evidence regarding efficacy (mood and rhythm) and tolerability across studies.

Results: We identified 6 studies including 272 participants (44% female). All studies used 25-50 mg AGO per day for treatment combined or not combined with mood stabilisers (MS). Across all 6 studies, there were improvements in depression evaluated by depression rating scores and response rate over time. The response rates varied from 43% to 91% within 6-12 weeks. Although AGO was found of better efficacy in bipolar depression compared to recurrent depression, its efficacy remains controversial. Most studies have shown AGO to be effective after just about a week. AGO was reasonably well tolerated both in acute and extension period, without obvious risk in inducing mood switching.

Conclusion: AGO is promising in treating bipolar depression with significant efficacy and well tolerability. However, more strictly designed and large-sample trials are needed in further research with homogeneity within intervention and treatment groups.

Background: Suicide attempts have been intensively examined in chronic schizophrenia (SCZ) patients with comorbid depression. This study aimed to investigate the prevalence and clinical correlates of suicide attempts in Chinese first episode drug-naïve (FEDN) SCZ patients with comorbid severe depression.

Methods: Totally 317 FEDN SCZ patients were recruited into the study. Patients were assessed for symptoms using the 24-item Hamilton Depression Scale (HAMD₂₄), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS). Plasma glucose and lipids were measured. A score of more than 35 on the HAMD₂₄ was defined as severe depression.

Results: Suicide attempts occurred at a higher rate in patients with severe depression than in those without (33.4% vs 16.7%). Among patients with severe depression, HAMD and PANSS total score were higher in suicide attempters compared to non-attempters (all p < 0.05). PANSS total score was independently related to suicide attempts in FEDN SCZ patients who had severe depression (OR = 1.02, p < 0.05).

Conclusion: Suicide attempts are more prevalent in FEDN SCZ patients with comorbid severe depression than in those without. Psychotic symptoms might be involved in suicide attempts in FEDN SCZ patients with severe depression, while depressive symptoms might not.

Background: The psychiatric phenotype of the 22q11.2 deletion syndrome (22q11DS) has been largely described.

Objectives: With a case-control study design, we now compared a sample of 22q11DS patients with a psychiatric diagnosis with a sample of psychiatric patients without 22q11DS to investigate possible differences between groups for depression severity, hopelessness, and suicide. Patients with 22q11DS were divided into two groups according to the levels of hopelessness to evaluate the relationship between hopelessness and the severity of the 22q11DS, the level of disability, functional impairment, physical frailty, and autonomy level.

Results: Results showed that suicide risk evaluated with the C-SSRS was similar in the two groups of patients and that a diagnosis of 22q11DS does not appear to be a risk factor for suicide; however, 22q11DS patients had more severe hopelessness. Patients with a more severe clinical presentation and worse overall functioning have higher levels of depressive symptoms and hopelessness.

Conclusions: The results suggest the need to assess and monitor psychiatric symptoms in patients with 22q11DS.