International Journal of Psychiatry in Clinical Practice最新文献

Background: We report a case on the efficiency of low-frequency repetitive transcranial magnetic stimulation (rTMS) on cigarette consumption cessation.The patient was 29 years old, He received intensive psychiatric treatments along with ten years of history of depressive and obsessive-compulsive disorders.The first four years of treatment were marked by good outcomes. However, the last 6 years were marked by persisting depressive symptoms associating with psychotic features and sexual obsessions.

Methods: The patient received 20 sessions of rTMS over two weeks, 10 times per week at 1 Hz frequency, each session lasted 20 min with 200 pulses and 100% of motor threshold. In the meanwhile, the patient continued his full drug-based treatment according to the reported prescription.

Results and conclusion: After 20 sessions, the patient reported a decreased severity of his depressive symptoms with a BDI (Beck Depression Inventory) score of 6 but without significant improvement of OCD with a YBOCS score of 32. However, the patient reported great improvement in his tobacco craving and a diminishing number of consumed cigarettes in the second week of the rTMS protocol of treatment. This ended with tobacco cessation within a month. However, this occurred without any medication or psychological support for treating tobacco dependence.

Objective: In this study, we wanted to investigate the usability of routine blood samples taken at the beginning of hospitalisation in inpatients to predict the presence of psychotic symptoms in patients.

Methods: We divided the hospitalised patients into two groups those with and without psychotic symptoms according to their ICD-10 diagnosis codes. Then, we compared the complete blood count, c-reactive protein (CRP), and fasting glucose levels, which can be used as simple markers of inflammation.

Results: In this retrospective study, which included 349 patients, we found that blood leukocytes, neutrophils, CRP, and fasting glucose levels were higher in patients with psychotic symptoms than in patients without psychotic symptoms (p = 0.015; p = 0.013; p = 0.002; and p = 0.001, respectively). According to regression analysis, patients with high glucose levels were 4.9 times more likely to have psychotic symptoms than those with low glucose levels. In addition, according to the ROC analysis results; when we used 87 mg/dl as the cut-off value for fasting glucose, it was observed that it predicted psychotic symptoms with approximately 69% sensitivity and 71% specificity.

Conclusion: Although our results still have some limitations, they are promising for the future use of simple biomarkers of inflammation for the differential diagnosis of psychiatric disorders.

Objective: To examine the relationship between coping strategies and the change in symptom severity in contamination-focused OCD patients during the COVID-19 pandemic over a one-year follow-up.

Methods: In March 2020, a one-year follow-up study was initiated with 56 contamination-focused OCD patients in Turkey. Coping strategies were evaluated using the COPE scale. OCD symptom severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at the beginning and end of the year. The Fear of COVID-19 Scale was administered mid-year.

Results: One year post the onset of COVID-19, 68% of patients showed increased OCD symptom severity, while 32% displayed a decrease. Higher scores on the fear of COVID-19 scale and lower acceptance scores from COPE subscales were correlated with increased OCD symptom severity.

Conclusions: The COVID-19 pandemic has intensified OCD symptoms in a substantial proportion of patients, particularly those with heightened fears related to the pandemic, and reduced acceptance-based coping strategies. Tailored interventions emphasising adaptive coping mechanisms may benefit OCD patients in managing their symptoms during external stressors like pandemics.

Objectives: Several studies consistently showed that patients with attention deficit hyperactivity disorder (ADHD) have high rates of hoarding disorder (HD) comorbidity. The aim of the present study was to compare the clinical and cognitive features of adult ADHD patients with and without hoarding comorbidity according to a self-report measure, and a sample of healthy controls.

Methods: Fifty-seven consecutive adult outpatients with a primary diagnosis of ADHD with comorbid hoarding disorder (ADHD+HD), 57 matched ADHD patients without hoarding disorder comorbidity (ADHD-HD), and a control group of 47 healthy controls (HCs) were enrolled. All subjects undergone a comprehensive clinical assessment and a neurocognitive assessment focused on attention, memory, and executive functions.

Results: The ADHD groups differed on most of the clinical and cognitive measures compared to HCs. ADHD+HD patients showed similar ADHD symptoms but greater subjective impulsivity, mood and anxiety symptoms, and a greater functional impairment compared to ADHD-HD patients as well as greater attentional and executive functioning impairments.

Conclusions: ADHD patients with comorbid hoarding disorder present a more complex clinical and neuropsychological phenotype correlated to a greater functional impairment compared to ADHD patients without this comorbidity. These results further highlight the relevance of assessing and treating hoarding behaviours in adults with ADHD.

Objective: Bipolar disorders (BD) are characterized by highly recurrent nature, necessitating adequate maintenance treatment for long-term disorder control. This study aimed to investigate real-world prescribing patterns among outpatients with BD, focusing on the utilisation of antidepressants (AD) and benzodiazepines (BDZ).

Methods: We analysed prescription patterns of the five main groups of psychotropic medications (antipsychotics, mood stabilizers, AD, BDZ, and anticholinergic medications) and their relationships with basic socio-demographic and clinical data in a sample of 107 clinically stable BD outpatients (75.7% female, age 44.8 ± 11.7).

Results: Maintenance therapy predominantly involved polypharmacy (92.5%), with mood stabilizers (87.9%) and antipsychotics (80.4%, predominantly second-generation) being the most commonly prescribed. Our findings highlight a high percentage of patients prescribed AD (50.5%) and BDZ (54.2%). BDZ patients, compared to the non-BDZ group in maintenance treatment, were significantly older with longer psychiatric history and a decreased likelihood of comorbid personality disorder diagnoses.

Conclusions: This study offers insights into prescribing practices within a university psychiatric clinic in the Western Balkans. The prevalent use of polypharmacy in real-world clinical settings, along with high percentage of patients prescribed AD and BDZ, suggests a gap between guideline recommendations and clinical practice, indicating a lack of consensus or standardized approaches in clinical practice.

Major Depressive Disorder (MDD) is a common condition with complex psychological and biological background. While its aetiology is still unclear, chronic stress stands amongst major risk factors to MDD pathogenesis. When researching on MDD, it is necessary to be familiar with the neurobiological effects of several prominent contributors to the chronic stress factor experienced across hypothalamic-pituitary-adrenal (HPA) axis, neurotransmission, immune system reflexivity, and genetic alterations. Bi-directional flow of MDD pathogenesis suggests that psychological factors produce biological effects. Here, a summary of how the MDD expresses its mechanisms of action across an overactive HPA axis, the negative impacts of reduced neurotransmitter functions, the inflammatory responses and their gene x environment interactions. This paper builds on these conceptual factors and their input towards the MDD symptomatology with a purpose of synthesising the current findings and create an integrated view of the MDD pathogenesis. Finally, relevant treatment implications will be summarised, along with recommendations to a multimodal clinical practice.