International Journal of Psychiatry in Clinical Practice最新文献

Background: The advantages of lithium in treating bipolar disorder (BD) are inconsistent with a declining trend in lithium prescriptions worldwide. Understanding lithium prescription patterns and serum concentrations could improve lithium clinical practices.

Methods: This multicentre study used latent variable analysis to explore lithium prescription patterns and changing trends in lithium serum concentrations. A regression model was used to identify their underlying associated factors.

Results: High- and low-dose prescription patterns were discovered in patients with mania and bipolar depression (BD-D), respectively. Patients with BD-D tended to receive lower lithium dosages. Lithium combination therapy was mainstream for BD. Factors associated with prescription patterns differed between patients with mania and BD-D. The lithium concentration-to-dose (C/D) ratio initially decreased but then increased. The final lithium serum concentration was mainly associated with dose titration.

Conclusions: In this study, lower lithium dosage combined with second-generation antipsychotics is commonly used in the treatment of BD, and lithium prescription patterns fail to follow the guideline recommendations for BD. There are episode-specific factors associated with lithium prescriptions. A non-linear trend in the C/D ratio appears to be one of the factors contributing to lithium delay effects. Adjusting the lithium dosage is a direct way to change its serum concentration.Key PointsLower lithium dosage combined with SGAs is commonly used in the treatment of BD, and lithium prescription patterns fail to follow the guideline recommendations for BD.Factors associated with lithium prescription patterns differed between patients with mania and BD-D.In the context of a standardised lithium dosage (1 g), lithium plasma levels initially decrease before gradually increasing, which appears to be one of the factors contributing to lithium delay effects.

Background: Treatment-resistant depression (TRD) remains a complex challenge, often requiring interventions beyond standard medications. This review explores factors that may predict positive response to electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS) and ketamine-based treatments to help guide clinical decision-making.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. English-language, peer-reviewed studies were identified through PubMed, Embase and Google Scholar using search terms such as 'treatment-resistant,' 'outcome,' 'prediction,' 'ECT,' 'rTMS,' and 'ketamine.' Studies were included if they examined clinical, biological or imaging predictors of response in adults with TRD. Case reports, reviews, editorials and non-English articles were excluded. A total of 42 studies were selected from 408 screened.

Results: Among these, 23 focused on ketamine/esketamine, 14 on rTMS, and 11 on ECT. Predictive factors were grouped into clinical (e.g., symptom profile, illness duration), biological (e.g., IL-6, CRP, BDNF) and imaging (e.g., cingulate cortex activity, connectivity). Inflammation markers and fronto-limbic network findings appeared across treatments, though findings were inconsistent.

Discussion: While some predictors show promise, clinical use remains limited by methodological differences and small sample sizes. Larger studies are required to identify clinically useful predictors. Additionally, for optimal treatment decision-making, comparative studies are necessary.

Objective: Regular physical activity benefits cardiometabolic health, fitness, neurocognition and quality of life in people with schizophrenia (pwSCZ). However, pwSCZ exhibit high levels of physical inactivity and poor adherence to exercise programs. This study investigated physical activity facilitators and barriers in stable pwSCZ in long-term psychosocial rehabilitation.

Methods: Forty-three pwSCZ (age = 29 (12) years; n = 12 female) of a French rehabilitation centre underwent semi-structured interviews and rated pre-identified physical activity barriers and facilitators on a 5-point scale.

Results: Two facilitator classifications (conventional and motivation-based) and one barrier classification emerged. Frequent facilitators included weight loss, improving well-being, enjoyment of activity and self-pride. Main barriers were fatigue, low motivation, lack of time or competing priorities, social difficulties, and addictive substance use.

Conclusions: While most factors are shared with other severe mental illnesses, social difficulties, addictive substance consumption and feelings of self-pride emerged more specifically in our sample. The motivational classification highlighted the prevalence of autonomous motivation, which supports durable behaviours. Barriers reflected schizophrenia-related symptoms not addressed by antipsychotics, underlining the need for multidisciplinary care, especially as some of them are not specific to physical activity uptake. Psychosocial rehabilitation settings could use our findings to adapt physical activity promotion in pwSCZ.

Objective: To compare self-reported anxiety, depression, insomnia, functional impairment, and substance use among distinct cohorts of new adult psychiatric outpatients before and after the onset of the COVID-19 pandemic.

Methods: Outpatient intake visit data, collected pre-pandemic (May 1, 2019-February 28, 2020) and early in the pandemic (May 1, 2020-February 26, 2021), included the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Work and Social Adjustment Scale (WSAS), and the World Health Organisation Alcohol, Smoking, and Substance Involvement Screening Test. Substance use treatment-seeking patients also completed the Brief Addiction Monitor. Analysis of variance models, adjusted for sex and race, examined between-cohort differences.

Results: Among 4,197 patients (pre-pandemic: 2,434; early pandemic: 1,763), anxiety and insomnia (GAD-7, ISI) symptoms were greater after pandemic onset. Depression (PHQ-9) and functioning (WSAS) were not different. Rates of cannabis, cocaine, and inhalant use were higher post-pandemic. Among substance use treatment seekers, drug and marijuana use was higher, with women reporting more binge drinking days.

Conclusions: New psychiatric outpatients who presented after the pandemic reported greater anxiety and insomnia symptoms and different substance use patterns vs. a pre-pandemic cohort, underscoring the need for targeted interventions during public health crises.

Objective: Gambling is a common activity that becomes problematic in some vulnerable individuals, with gambling disorder (GD) now recognised as a bona fide mental/brain disorder. Several factors are associated with vulnerability to developing GD, including other mental disorders and pathological personality traits like high impulsivity. This clinical condition, referred to as Dual Gambling Disorder (GDD), better captures the broader psychopathological spectrum of GD.

Methods: This narrative review addresses recent advances in neuroscience and psychiatry that can help design more effective prevention strategies for GD. After establishing the current state of the art regarding GD/GDD from a biopsychosocial perspective, we assess the scientific evidence supporting approaches to GDD prevention.

Results: Following an overview of GD/GDD, we examine how precision psychiatry can not only shape therapeutic interventions but also, evidence-based prevention strategies for GD, and how these strategies align with advances in clinical neuroscience and precision psychiatry. Prevention is analyzed across multiple levels: primordial, primary, secondary, and tertiary. Finally, we outline key elements to be considered when designing scientifically grounded prevention strategies for specific target populations.

Conclusions: The development of preventive strategies for GD, particularly when arising alongside other mental disorders, must be grounded in scientific evidence from neuroscience and precision psychiatry.

Oxidative stress and enhanced free radical production with subsequent mitochondrial dysfunction and neurodegeneration are major pathomechanisms for the ageing spectrum of neurocognitive disorders ranging from subjective cognitive decline over mild cognitive impairment to Alzheimer's disease (AD) and vascular mild cognitive impairment (MCI) and vascular dementia (VD). Due to its radical scavenging, antioxidative and mitochondrial function-improving properties standardised Ginkgo biloba extracts (GBE) target several key processes of neurodegeneration. These include mitochondrial dysfunction, impaired mitochondrial quality control, and reduced energy metabolism. GBE's benefits also include supporting neuroplasticity, the brain's ability to form new neural connections, and reducing neuroinflammation, a major driver of disease progression in neurodegenerative conditions. As a consequence, GBE improves several aspects of cognitive dysfunction within the broad spectrum of neurocognitive disorders as indicated by a large body of evidence from randomised controlled studies.

Objective: Major depressive disorder (MDD) is a prevalent disabling condition, with psychotic features complicating its course and management. Purpose of the study is to identify clinical and biochemical factors differentiating psychotic from non-psychotic MDD.

Methods: This is a retrospective single-centre study conducted on patients hospitalised between 2002 and 2022 at Fondazione IRCCS Policlinico (Milan, Italy) with a diagnosis of MDD. A large set of clinical and biochemical variables was collected on the first day of hospitalisation. Patients were divided according to the presence or absence of lifetime psychotic symptoms and compared by Student's t-test for continuous variables and Chi-square tests for categorical ones. The statistically significant continuous variables were inserted in a binary logistic regression model as independent predictors of lifetime psychotic symptoms.

Results: No statistically significant differences in biochemical parameters (p > 0.05) were found in the two groups. The logistic regression model showed that depressed patients with lifetime psychotic symptoms had a significant longer duration of hospitalisation (p = 0.007), more lifetime suicide attempts (p = 0.035) and higher BPRS scores (p = 0.004) than the counterpart.

Conclusions: Lifetime psychotic symptoms confer a more severe course of illness in patients with MDD. No biochemical parameter resulted as a biomarker of MDD psychotic subtype.

Objective: Given evidence for oxidative dysregulation in bipolar disorder, we examined thiol-disulphide balance (TDB) as a redox biomarker and evaluated the impact of electroconvulsive therapy (ECT) on TDB to clarify redox contributions to BD pathophysiology.

Methods: This observational mixed design study comprising cross-sectional case-control comparisons of BD-ECT(n = 31), BD-non-ECT (n = 46), healthy control (n = 42) groups and within-subject repeated-measures assessments across phases (mania, post-ECT where applicable, remission) in bipolar disorder, quantifying native thiol, disulphide, and total thiol to derive TDB ratios, with FDR-adjusted statistics.

Results: Compared with healthy controls, native thiol was lower in both manic and remission phases (e.g., Mania(299.4 ± 81.16) vs. HC(379.91 ± 48.93); p < 0.001), while disulphide was higher (e.g., Remission(22.85 ± 5.07) vs. HC(17.66 ± 4.96); p < 0.001). Within the ECT group, no significant within-patient changes in TDB indices were observed across time points (all p > 0.05).

Conclusion: We observed a shift of thiol-disulphide balance (TDB) towards oxidative predominance in both manic and remission phases of BD with no significant ECT-related modulation of TDB during mania. These findings highlight the need for a comprehensive examination of the impact of oxidative stress on the underlying mechanisms of BD and potential therapeutic mechanisms of ECT.

Objective: Anxiety disorders represent a major and growing global health issue, particularly among adolescents and young adults. This study analyzes the burden and trends of anxiety disorders in individuals aged 10-24 from 1990 to 2021.

Methods: Using data from the Global Burden of Disease Study 2021, we examined global, regional, and national incidence, prevalence, and disability-adjusted life years (DALYs) for anxiety disorders. Analyses were stratified by gender and age, and the association with the sociodemographic index (SDI) was assessed.

Results: The global burden of anxiety disorders in youth increased overall, with a sharp rise after 2019. In 2021, there were 16.67 million new cases globally among 10-24-year-olds, a 52% increase since 1990. Females consistently bore a higher burden than males (incidence rate: 1062.86 vs. 712.09 per 100,000). India, China, and the USA had the highest number of cases. A weak positive correlation was found between SDI and anxiety disorder burden.

Conclusions: The escalating burden of anxiety disorders among global youth necessitates enhanced mental health education, public awareness, and targeted interventions. School-based mental health literacy programs and expanded telehealth services are urgently needed, especially in low- and middle-income countries. Further research into mechanisms and equitable access to care is crucial.