International Journal of Psychiatry in Clinical Practice最新文献

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.

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.

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: 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.