International Journal of Psychiatry in Clinical Practice最新文献

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.

Objective: To analyse the use of antipsychotics for first-episode of psychosis (FEP) and relapsed schizophrenia, and the impact of predominant symptoms on decision making.

Methods: A survey among 150 European psychiatrists was conducted using computer-assisted web interviewing to assess preferred medications, switching, dose adjustments, and maintenance therapy in acute FEP and relapse settings.

Results: Negative or affective symptoms were reported as prevalent in 55% of FEP and 59% of relapsed schizophrenia cases, indicating significant unmet treatment needs. Olanzapine and risperidone were the most commonly prescribed antipsychotics for FEP, with treatment choices influenced by symptom profiles. Long-acting injectables (LAIs) were prescribed to 28% of FEP patients, with notable variation across countries (15-43%; p < 0.05). During hospitalisation, 41% of patients required therapy adjustments, while discharge decisions were driven by drug tolerability and symptom severity. For relapsed patients, non-adherence was identified as the primary cause of relapse (71%), and olanzapine, risperidone, and aripiprazole were the most prescribed treatments. Post-discharge adjustments for relapsed patients focused on adherence and long-term treatment goals.

Conclusion: Despite the prevalence of negative or affective symptoms in FEP and relapsed patients, traditional antipsychotics remain the most prescribed treatments. Non-adherence and variability in LAI usage highlight the need for improved symptom-specific approaches and standardised LAI protocols.

Objective: The potential risk of diagnostic conversion from unipolar depression to bipolar disorder with antidepressant use, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs) versus selective serotonin reuptake inhibitors (SSRIs), remains debated. This study aims to investigate the relationship between SSRI and SNRI use and the risk of diagnostic conversion.

Methods: We conducted a retrospective cohort study using the Korean version of the Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM). The target cohort comprised patients prescribed SNRIs, while the comparator cohort included those prescribed SSRIs. The primary outcome was a new diagnosis of bipolar disorder occurring at least six months after antidepressant initiation.

Results: After propensity score adjustment, no significant difference in the risk of diagnostic conversion was observed between SSRI and SNRI users. In the distributed network analysis, SNRI use was not significantly associated with an increased risk of diagnostic conversion compared to SSRI use after both 1:1 propensity score matching (hazard ratio [HR] = 1.28, 95% confidence interval [95% CI]: 0.90-1.82; I² = 24.1%) and 1:2 propensity score matching (HR = 1.16, 95% CI: 0.88-1.53, I² = 0%).

Conclusions: This study observed no significant difference in the risk of diagnostic conversion to bipolar disorder between SSRI and SNRI users.

Objective: This study aims to evaluate the short-term efficacy, safety, tolerability, and side effect profile of the two-injection start (TIS) regimen of aripiprazole once-monthly long-acting injection (AOM 400 mg) in individuals diagnosed with schizophrenia.

Methods: This retrospective study included 50 patients diagnosed with schizophrenia according to DSM-5 criteria who received the TIS regimen of AOM 400 mg. Patients were divided into two groups: those followed with AOM monotherapy (Group 1) and those receiving AOM with oral agents (Group 2). Assessments included the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression scales (CGI-S, CGI-I, CGI-SE), and the Global Assessment of Functioning (GAF). Evaluations were performed at baseline and at weeks 1, 2, and 4. Hospital stay duration and side effects were recorded.

Results: Both groups showed significant reductions in hospital stay and PANSS scores, with improved GAF and CGI-I scores (p < 0.001). No serious side effects occurred, and mild effects resolved by week 4.

Conclusion: The TIS regimen of AOM 400 mg demonstrated rapid symptomatic and functional improvement with good tolerability. Further large-scale prospective studies are warranted.

Objective: Previous studies have identified visual perception and functional impairments in individuals with schizophrenia, particularly in areas such as contour integration and contrast sensitivity. These deficits can significantly impact daily functioning and social interactions. This study aims to investigate the impact of a visual remediation intervention (VRI) on visual perception deficits, specifically contour integration and contrast sensitivity, while also assessing its effects on social cognition, visual attention, and disease symptoms.

Methods: Forty schizophrenia patients were randomly assigned to a VRI group or control group (treatment as usual). The VRI group completed 30 sessions of the 'Sightseeing' program over 10 weeks. Pre- and post-treatment assessments included measures of social cognition, visual attention, psychopathology, contour integration, and contrast sensitivity.

Results: Following intervention, the VRI group showed significant improvements in contrast sensitivity, social cognition, visual attention, and contour integration tasks, along with reduced disease symptoms.

Conclusions: The 'Sightseeing' VRI program demonstrated beneficial effects across multiple domains in schizophrenia patients. These findings suggest potential implications for future therapeutic interventions. However, it should be noted that the control group did not receive an intervention or placebo condition, which represents a limitation of the study.

Objectives: Psoriasis is a chronic inflammatory, autoaggressive disease. It is known that psychiatric comorbidity in psoriasis contributes to the progression and exacerbation of the disease. This study aims to examine psychiatric disorders and personality traits in a sample of patients with psoriasis.

Methods: Personal information forms, General Health Questionnaire (GHQ-12), Hospital-Anxiety-Depression Scale (HADS), Five-Factor Personality Inventory Short Form (BFI) were used for all participants. Psoriasis patients were evaluated with clinical information form, Dermatology Life Quality Index (DLQI), and psoriasis-area-severity-index (PASI). Psychiatric disorders were investigated with the Structured-Clinical-Interview for DSM-IV (SCID) diagnosis.

Results: A total of 129 participants completed the case-control study. Psoriasis patients' HADS-total score showed positive correlation with the PASI and DLQI score. SCID interview was conducted with 39(66.1%) psoriasis patients with GHQ-12 score of ≥2, and 25 patients (42.4%) received at least one psychiatric diagnosis. Conscientiousness, agreeableness, and stability were higher in patients with psoriasis than in healthy controls. In psoriasis patients with a psychiatric diagnosis, Plasticity, and Openness to experience personality traits scores showed a significant decrease with a medium effect size. In psoriasis patients without a psychiatric diagnosis, high stability scores were associated with positive emotionality and social well-being, while low plasticity levels were determined as predictors of psychopathology.

Conclusion: In improving the quality of life of psoriasis patients, it is important to plan effective treatments for both psoriasis and psychopathology and to evaluate biological vulnerabilities such as personality traits in terms of the risk of comorbid psychopathology.

Keypoints: In psoriasis patients with a psychiatric diagnosis, Plasticity, and Openness to Experience personality traits scores showed a significant decrease with a medium effect size.Plasticity predicted psychiatric diagnosis significantly, and negatively in psoriasis patients.In psoriasis patients without a psychiatric diagnosis, high stability scores were associated with positive emotionality and social well-being, while low plasticity levels were determined as predictors of psychopathology.

Objective: To evaluate the effects of different management strategies (watchful waiting, dose reduction, switching and adjunctive treatments) on prolactin levels and clinical outcomes in patients with antipsychotic-induced hyperprolactinaemia.

Methods: A prospective cohort study was conducted with 135 adult patients diagnosed with hyperprolactinaemia due to antipsychotic use. Patients were assigned to four management groups: watchful waiting, dose reduction, switching and adjunctive treatment (with aripiprazole). Prolactin levels and clinical symptoms (e.g. galactorrhea, gynaecomastia, menstrual irregularities) were assessed before and after intervention.

Results: Baseline prolactin levels were comparable across groups. Post-intervention, all groups exhibited significant reductions in prolactin levels, with the largest decrease observed in the switching and adjunctive treatment group (mean change: -68.3 and -67.1 ng/mL, respectively). Clinical outcomes also improved, with a notable reduction in galactorrhea (p = 0.04), gynaecomastia (p = 0.004) and menstrual irregularities across all groups (p = 0.02). No significant changes were observed in sexual dysfunction, hirsutism or acne.

Conclusion: Management strategies for antipsychotic-induced hyperprolactinaemia, particularly switching or adjunctive treatments, effectively reduce prolactin levels and improve related symptoms.