International Journal of Psychiatry in Clinical Practice最新文献

Objective: Cognitive Reactivity (CR) is the (re-)activation of negative cognitions by dysphoric mood. We examined whether CR predicts depressive episodes across 2 and 9 years, beyond subclinical depressive symptoms, neuroticism, and previous depressive episodes.

Methods: Participants (N = 1,734) from the Netherlands Study of Depression and Anxiety (NESDA) were never-depressed or remitted-depressed for ≥1 month prior to baseline. We examined 2-year and 9-year predictions using Cox's survival analysis and logistic regression, respectively. Two-year coefficient-based weight-points were calculated and evaluated using ROC analysis.

Results: CR was a statistically-significant predictor of two-year depressive episodes, with an odds ratio of 1.04, 95% CI (1.02-1.06), and over nine years, with an adjusted hazard ratio of 1.01, 95% CI (1.01-1.02). The influence of CR and subclinical depressive symptoms decreased as the number of episodes increased, especially in ≥ 3 past episodes. Calculated weight-points correctly predicted 33.5% of participants who developed 2-year depression, compared to a 17.8% base rate (sensitivity = .81, specificity = .66).

Conclusions: CR is a moderately strong predictor of depressive episodes across 2 and 9 years. In participants with ≥ 3 prior episodes, depression history is such a strong predictor that a ceiling effect occurs, removing any added value of other predictors.

Introduction: This study aimed to evaluate the sociodemographic factors, loss-related factors, and adult separation anxiety associated with a diagnosis of Prolonged Grief Disorder (PGD), after controlling for anxiety, depression, and perceived social support during the COVID-19 pandemic in Türkiye.

Methods: Participants (n=126) completed an online survey that included socio-demographic and loss-related information, as well as the Hospital Anxiety and Depression Scale, Prolonged Grief Disorder Scale-13, Multidimensional Scale of Perceived Social Support, and Adult Separation Anxiety Questionnaire-27.

Results: Twelve participants were diagnosed with probable PGD (9.5%). In the linear regression analysis, it was found that when the deceased person was a first-degree relative and younger in age, the presence of guilt, increased separation anxiety, and higher depression scores significantly associated with the severity of PGD.

Conclusion: Even when the pandemic is under control, it remains crucial to offer mental health services those who have lost a loved one during the COVID-19 outbreak.

The use of electroconvulsive therapy (ECT) during twin pregnancy has been insufficiently studied, and there is limited evidence regarding its safety. Here, we present a case of successful use of ECT for severe major depressive disorder during twin pregnancy. The patient suffers from psychotic depression with catatonic presentation and Cotard syndrome (delusions with denial of internal organs). This case illustrates the difficulty in managing severe antenatal depression and addresses the guidelines for the ECT protocol (anaesthetic modalities, obstetrical monitoring, and duration of treatment) during twin pregnancy.

Objective: Mitochondria are essential for energy production and reactive oxygen species (ROS) generation, with changes in ROS levels or energy demands affecting mitochondrial DNA (mtDNA) copy numbers, indicating mitochondrial function. Early life adversity (ELA) affects mitochondrial dynamics, influencing long-term health. Both ELA and mitochondrial abnormalities have been independently associated with bipolar disorder (BD). This study aims to explore the complex interplay between mitochondrial dysfunction, ELA, and BD.

Methods: The study included 60 participants diagnosed with BD and 66 healthy controls (HCs). Data were collected using the Childhood Trauma Questionnaire (CTQ), and leukocyte mtDNA copy number (MCN) was determined from blood samples.

Results: The results indicated the CTQ sum scores were significantly higher in the BD group, reflecting greater exposure to ELA. In HCs, a marginally significant nonlinear relationship between the square of the CTQ sum score and MCN was found. Further analysis demonstrated a significant interaction between ELA and BD on MCN (p = 0.023), highlighting a critical connection between ELA and mitochondrial dysfunction in BD and reinforcing its biological underpinnings.

Conclusions: Future treatments for BD might target mitochondrial dysfunctions related to chronic stress, with potential pharmaceuticals designed to address these issues and mitigate the negative effects of chronic stress.

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: 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.

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.