International Journal of Psychiatry in Clinical Practice最新文献

Objectives: The aims of this study were to estimate the frequency of 'sundown syndrome' (SS) in a large sample of patients with Alzheimer's disease (AD) and to assess its associated socio-demographic and clinical variables.

Methods: Three hundred and sixty-one AD patients (age 78.4 ± 8.3 years) collected within the National Institute of Mental Health Genetics Initiative were included. A subsample was autopsy-confirmed. SS was identified within a caregiver-structured interview. Sociodemographic, clinical and neuropsychiatric features of sundowners and non-sundowners were compared by logistic regression.

Results: One hundred eighty-five patients (51.2%) were sundowners. SS was positively associated with several neuropsychiatric symptoms (i.e., hallucinations, suspiciousness, wandering and aggression; all p-values < 0.01), and negatively associated with Mini-Mental State Examination and voluptuary habits (all p values < 0.05). Subsample analysis carried out in the autopsy group confirmed the findings.

Conclusions: SS is common in AD and is associated with several neuropsychiatric features and voluptuary habits. The identification of SS predictive factors may allow preventive and targeted therapeutic interventions.

Background: Treatment-Resistant Depression (TRD) often persists despite adequate pharmacotherapy. Intranasal Esketamine and accelerated repetitive Transcranial Magnetic Stimulation (aTMS) are rapid-acting options, but head-to-head comparisons remain limited.

Methods: We conducted a retrospective study on TRD patients receiving either aTMS (n = 18) or Intranasal Esketamine (n = 22). Depression severity (Montgomery-Asberg Depression Rating Scale, MADRS) was assessed at baseline and 1, 3, and 6 months. Primary outcomes were response (≥50% MADRS reduction) and remission (MADRS <10). Longitudinal change was modelled with linear mixed-effects; moderators included clinical and demographics features.

Results: At 1 month, aTMS showed higher response (72.2% vs 20%; p < 0.001) and remission (66.6% vs 10%; p = 0.0031) than Esketamine. Between-group differences were not significant at 3 months or 6 months. Mixed-effects models showed greater MADRS reduction with aTMS at 1 (p < 0.001) and 3 months (p = 0.007), but not at 6 months (p = 0.057). Psychiatric comorbidities were associated with greater improvement at 3 and 6 months within the Esketamine subgroup, with no analogous association in the aTMS subgroup.

Conclusions: aTMS showed a stronger early antidepressant effect, but its advantage over esketamine progressively diminished and was no longer evident at six months. Prospective, well-powered comparative trials are required to validate these findings.

Objective: To evaluate the effects of risperidone on cardiovascular risk.

Method: The searches were completed by means of EMBASE, MEDLINE/PubMed (by the National Library of Medicine), Scopus, and Web of Science databases. We included SRs of risperidone and cardiovascular risk published up to 2022. PRISMA was enforced for reporting quality, AMSTAR 2 was used to assess methodological quality, and GRADE was executed for quality of evidence analysis.

Results: After excluding 1883 publications, we identified six systematic reviews, which reported effect estimates with substantial uncertainty for tachycardia events (RR 1.35, 95% CI 0.87 to 2.10), QTc prolongation events (RR 1.02, 95% CI 0.94 to 1.10), and QTc prolongation as a continuous outcome (mean difference +9.39 ms, 95% CI 4.09 to 14.69). For systolic and diastolic blood pressure, extractable mean differences (mmHg) were not reported, limiting quantitative interpretation. Overall certainty of evidence ranged from low to very low. No SR entirely adhered to the PRISMA statement, AMSTAR 2 and GRADE suggested low to very low quality.

Conclusion: The available evidence from systematic reviews is of low to very low certainty and indicates substantial uncertainty regarding the cardiovascular effects of risperidone. Higher-quality systematic reviews with improved reporting and methodology are required.

Background: Insomnia has a significant impact on metabolic changes and cognitive impairments in schizophrenia (SCZ) patients. This study aimed to explore these relationships in SCZ patients.

Methods: A total of 609 SCZ patients were recruited. Insomnia was assessed using a self-reported questionnaire with three questions. The psychopathology and cognitive functioning were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Repeated Battery for Assessment of Neuropsychological Status (RBANS), respectively.

Results: SCZ patients with insomnia exhibited lower diastolic blood pressure (DBP), higher total cholesterol (TC) and poorer cognitive performance in language, attention, delayed memory and RBANS total score compared to those without insomnia (all p < 0.05). In SCZ patients with insomnia, fasting glucose contributed to immediate memory and RBANS total scores (all p < 0.05). In SCZ patients without insomnia, fasting glucose contributed to immediate memory (Beta = 0.223, t = 4.462, p < 0.001), triglycerides and DBP to visuospatial/constructional (all p < 0.05), and triglycerides to delayed memory (Beta = 0.118, t = 2.060, p = 0.040).

Conclusions: Our findings underscore the importance of addressing both metabolic and cognitive factors in SCZ patients with insomnia.

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 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 purpose of this study was to investigate the relationship between emotional difficulties and auditory processing.

Methods: A total of 94 students aged 18 to 30 years participated in this cross-sectional study. After assessing the level of anxiety and depression with Beck questionnaires, the performance of auditory processing was examined with dichotic digit (DDT), pitch pattern (PPST), quick speech in noise tests (QSIN), Digit span tests (DST), such as Digit Span Forward (DSF) and Digit Span Backward (DSB) and hyperacusis questionnaire (HQ).

Results: Out of 94 participants, 68 individuals (72.3%) experienced some degree of anxiety and depression. A significant relationship was found between anxiety and HQ. There was no relation between anxiety and DSB, DDT, PPST, and QSIN. There was a significant correlation between depression and QSIN. There was no relationship between depression, HQ, DDT, PPST and DSB. The results indicated that anxiety and depression on their own are not correlated with DSF.

Conclusion: This study suggests a weak relationship exists between hyperacusis and anxiety. Moreover, emotional factors like anxiety and depression may not have an impact on certain auditory processing functions.

Aim: This study aims to investigate the stress and death anxiety levels of individuals who experienced the earthquake after the major earthquakes that occurred in the Pazarcık and Elbistan districts of Kahramanmaraş in Turkey on February 6, 2023.

Methods: The study, which used a descriptive design, was conducted between May 2023 and July 2023, with 408 individuals who agreed to participate in the study and met the inclusion criteria in the provinces affected by the earthquake. Data were collected through the 'Personal Information Form' including questions about individuals' socio-demographic characteristics, the 'Death Anxiety Scale' and the 'Post-Earthquake Trauma Level Determination Scale'.

Results: The Death Anxiety Scale (DAS) mean scores indicated significant differences according to age, gender, and the presence of a personal or family disaster plan (p < 0.05). A significant difference was found between the Post-Earthquake Trauma Level Determination Scale (PETLDS) mean scores according to gender, employment, income level, loss of a relative due to the earthquake, and physical injury during the earthquake (p < 0.05).

Conclusions: Results showed that the participants were exposed to a moderate level of death anxiety and a high level of trauma after the earthquake. It was also found that the level of trauma increased with the increase in death anxiety.

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.

The aim of the study was to estimate the prevalence of hallucinations in patients with AD and to assess its associated clinic-demographic and neuropsychiatric profile. Three hundred and eighty-one patients collected within the National Institute of Mental Health Genetics Initiative were included. Characteristics of hallucinators and non-hallucinators were compared by logistic regression. One hundred sixty-nine (44.4%) patients were hallucinators. Hallucinators presented a more severe AD than non-hallucinators with a lower MMSE (10.6 ± 8.9 versus 14.6 ± 8.9; OR 0.9; 95%CI 0.92-0.97; p-value < 0.001) and a higher CDRS (2.7 ± 1.0 versus 2.4 ± 1.1; OR 1.2; 95%CI 1.01-1.44; p-value 0.035). Hallucinators presented a more severe neuropsychological profile, characterised by apathy, verbal and physical aggressivity, and wandering. Hallucinations may represent a clinically useful tool for identifying patients who may require more intensive interventions.