International Journal of Psychiatry in Clinical Practice最新文献

Objective: In this study we assessed if the genetic variation and gene expression of stress-associated mediators contribute to First Episode in Psychosis (FEP) and explored how mRNA levels of Hypothalamus-Pituitary-Adrenal (HPA) axis mediators change after treatment with antipsychotics.

Methods: We genotyped FKBP5 and SLC6A4 variants and associated them with Positive and Negative Syndrome Scale (PANSS). We assessed the mRNA levels of HPA axis mediators in FEPs before and after treatment with antipsychotics, while comparing them to matched controls.

Results: FKPB5 rs1360780 T allele was associated with higher and lower scores in the PANSS-Negative and PANSS-General scales. FKPB5 rs3800373 C allele carriers had lower risk to suffer from FEP. FEP individuals had decreased NR3C2 and increased FKBP5 and GILZ/TSC22D3 mRNA levels. After treatment, the mRNA levels of GILZ/TSC22D3 were comparable to those of the control group. Higher FKBP5 and GILZ expression levels were associated with higher risk for FEP occurrence and the difference in FKBP5 and GILZ expression levels before and after treatment with antipsychotics was associated with the difference in PANSS-T scores.

Conclusion: The data above, pinpoint towards a dysregulated HPA axis, that putatively affects the outcome and symptomatology of a First Episode in Psychosis.

Background: This prospective study aims to investigate the effects of exercise on clinical symptoms, cognitive performance, and quality of life in schizophrenia patients treated with clozapine.

Methods: Fifty-six (n = 56) participants were completed as the physical exercise group (PEG) (n = 28) and control group (CG) (n = 28). The PEG participated in an exercise program lasting 30 min, three times a week, for 12 weeks, in addition to a routine ergotherapy programme. The CG did not receive any treatment other than ergotherapy programme. Sociodemographic characteristics, Positive and Negative Syndrome Scale (PANNS), Brief Psychiatric Rating Scale (BPRS), Montreal Cognitive Assessment (MOCA), and The World Health Organisation Quality of Life (WHQOL-BREF) evaluated at baseline and after 12 weeks for both groups.

Results: After intervention, a statistically significant increase was observed in the MOCA and the psychological health sub-parameter of WHQOL-BREF in the PEG (p ≤ 0.05). According to the intergroup change analysis, the changes in the cognitive performance and psychological health sub-parameter of quality-of-life scores were significantly higher in the PEG than in the CG (p ≤ 0.05).

Conclusion: The demonstrated improvement in cognitive performance and psychological health in patients with schizophrenia treated with Clozapine through physical exercise strongly advocates for the inclusion of structured exercise programs in comprehensive treatment plans.

Objective: To inform clinical decision-making for patients with obesity, binge eating disorder (BED) and bipolar disorder (BD), we compared individuals with BED and those without BED who participated in a randomised controlled trial (RCT) of liraglutide for weight loss in stable BD with obesity.

Methods: This was a post hoc analysis of a published, 40-week, placebo-controlled, double-blind trial of liraglutide in 60 participants with stable BD and obesity or overweight. Participants with BED were compared to those without BED regarding demographics, psychiatric and medical comorbidity, BD treatment, and response to liraglutide versus placebo.

Results: Compared to those without BED (N = 43), participants with BED (N = 17) had a higher body mass index (BMI) and higher HbA1c levels, were taking more antidepressants, and had higher Binge Eating Scale (BES) scores and Three Factor Eating Questionnaire (TFEQ) disinhibition of eating and hunger subscale scores. Among the 17 BED participants, liraglutide (N = 9) and placebo (n = 8) were associated with similar reductions in percent change of body weight and BES scores. Liraglutide was well tolerated, but the BED group experienced significantly more nausea/vomiting (p = .04), constipation (p = .02) and anxiety (p = .02).

Conclusions: RCTs are warranted to enrich the pharmacological armamentarium available to treat such complex patients.

Objectives: Prolactin elevation is a common adverse effect of antipsychotic medications. The study aimed to explore the potential of metformin in managing olanzapine-induced hyperprolactinaemia.

Methods: A prospective study was designed to investigate the changes in prolactin levels over an eight-week metformin treatment. Thirty-one patients with schizophrenia (aged 18-60 years) on a stable dose of olanzapine for at least three months were enrolled. Participants received metformin at 1500 mg/day for eight weeks. Prolactin levels and metabolic parameters were measured at baseline and at weeks 2, 4, 6, and 8.

Results: After eight weeks of metformin intervention, prolactin levels significantly decreased from 39.7 ± 20.0 ng/mL at baseline to 35.7 ± 15.7 ng/mL (p = 0.005) with a moderate effect size (Cohen's d = 0.545). Reductions in prolactin levels correlated positively with baseline prolactin levels (r = 0.72, p < 0.001) and baseline glucose levels (r = 0.47, p = 0.008). Body weight, BMI, insulin level, glucose level, and insulin resistance significantly decreased after metformin treatment.

Conclusion: Although participants experienced mild hyperprolactinaemia, metformin effectively counteracted prolactin elevation and improved metabolic parameters. This study highlights metformin's potential to mitigate antipsychotic-induced adverse effect.

Antipsychotic drugs are used in the treatment of many mental disorders, especially psychotic disorders, bipolar disorders and neurodevelopmental disorders in children and adolescents. Antipsychotics, along with their effectiveness in treatment, have also been associated with a number of adverse effects. One of these is hyperprolactinaemia (hyperPRL) that occurs with antipsychotics. This situation is thought to be due to dopamine blockade in the tuberoinfundibular pathway, which has an effect on prolactin release. Hereby, we present a 15 year old female adolescent bipolar disorder type 1 case who developed hyperprolactinaemia with risperidone treatment which was ameliorated with metformin use (850-2000 mg/day). Although there are studies showing that metformin can be used in the treatment of hyperprolactinaemia, as far as we know, there are not enough studies on the use of metformin in adolescents. Future studies are needed to elucidate the risk factors, aetiological mechanism and treatment alternatives of this adverse effect, which occurs due to antipsychotics and may negatively affect medication compliance.

Background: Electroconvulsive therapy (ECT) has long been considered the main method of treatment for patients with resistant major depressive disorder (MDD). Recent studies have shown that ketamine infusion can also effectively improve treatment-resistant MDD. Thus, we conducted this meta-analysis to compare the efficacy of ketamine with ECT for treating treatment-resistant depression.

Methods: We systematically searched PubMed, the Cochrane Library, Scopus and Web of Science from the inception to 2 October 2024, to identify clinical trials and randomised controlled trials comparing the effect of ketamine with ECT on treatment-resistant major depression.

Results: Six studies with 353 individuals in the ketamine group and 323 individuals in the ECT group were included. No significant differences were observed between ECT and ketamine in terms of response to treatment (RR 1.03, 95% CI (0.78, 1.37), I² = 77.14%, T² = 0.08), MADRS score (weighted mean difference (WMD) 0.98, 95% CI (-5.04, 7.00), I² = 94.74%, T² = 26.52), remission (RR 0.65, 95% CI (0.16, 2.64), I² = 89.77%, T² = 1.19), relapse (RR 0.93, 95% CI (0.50, 1.72), I² = 20.13%, T² = 0.04) and the number of those experiencing adverse events (RR 0.72, 95% CI (0.47, 1.10), I² = 0.00%, T² = 0.00).

Conclusion: These findings suggest that ketamine is not inferior to ECT for treating MDD; however, future studies are needed for validation.

Objective: This meta-analysis compares intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) in treating schizophrenia, focusing on efficacy and safety.

Methods: Data from seven randomised trials (N = 440) were analysed. Outcomes included symptom severity (PANSS scales), cognitive function and adverse events. Effect sizes were calculated using RevMan version 5.3.

Results: No significant differences were observed for total psychopathology (SMD = -0.15), positive symptoms (SMD = 0.40) or general psychopathology (SMD = -0.58) (all p > 0.05). A reduction in negative symptoms was noted for iTBS compared to rTMS (SMD = -0.43, 95% CI: -0.82 to -0.03; p = 0.04; I² = 70%). Three studies reported cognitive benefits with adjunctive iTBS (p < 0.05). Safety outcomes, including discontinuation rates (RR = 0.77) and adverse events (headache/dizziness/fatigue), showed no group differences (p = 0.26-0.54).

Conclusions: iTBS shows specific efficacy for schizophrenia-related negative symptoms versus rTMS, with comparable safety. Larger trials are needed to confirm clinical applicability.

Introduction: The triazolopyridine derivative trazodone is approved for the treatment of major depressive disorder (MDD) in adults; according to the available literature, this molecule, through a specific dose-dependent profile of action, was found to be a potential therapeutic option in some neurological conditions. This systematic review aimed to synthesise the available evidence on the use of trazodone in neurological patients.

Methods: PubMed was searched for articles published from inception until March 2025. Article reference lists were screened, and relevant articles were retrieved for consultation. Clinical trials specifically investigating trazodone in neurological populations were included, following PRISMA guidelines for systematic reviews.

Results: Out of 69 records initially retrieved, 14 studies met the inclusion criteria, comprising 13 randomised controlled trials and 1 retrospective study, with a total of 608 patients. Most of the included studies focused on individuals with dementia, while others explored its use in different neurological disorders.

Conclusions: Despite being an older antidepressant, trazodone remains widely prescribed. Beyond treating depression in neurological patients, it may may be useful in the treatment of some neurological aspects. However, current evidence remains limited. Further high-quality research is necessary to better define the therapeutic potential of trazodone in the management of neurological conditions.

Background: Perimenopausal depression (PMD) is a common condition among women transitioning to menopause, characterised by various physical and psychological symptoms.

Method: This review explores the aetiology, clinical manifestations, and latest treatment approaches for PMD, highlighting the complexity and multi-factorial nature of the disorder.

Outcome: Key treatment strategies include hormone replacement therapy (HRT), antidepressants, traditional Chinese medicine (TCM), cognitive-behavioral therapy (CBT), and lifestyle modifications.

Conclusion: Comprehensive and individualised treatment plans are essential for effectively managing PMD and improving the quality of life for affected women.

Objective: Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are severe, commonly co-occurring disorders. AN and OCD comorbidity is associated with worsened prognosis and treatment responses, so better understanding treatment efficacy across both disorders could improve outcomes. We conducted the first known systematic review of non-pharmacological treatment efficacy for comorbid AN and OCD.

Methods: A systematic review of PubMed, PsycNet, Scopus, ProQuest and Google Scholar, up to and including January 2024, yielded 14 studies. PRISMA methodology was used. The study was preregistered (PROSPERO CRD42024507762).

Results: AN symptoms tended to improve while OCD symptoms did not. Most studies looked at treatments developed for AN. Studies examined a range of treatment types (e.g., deep brain stimulation and family-based therapy), study types (e.g., case study, single-arm and randomised controlled trial) and spanned all levels of care. Participants were mostly patients with AN, and many also had OCD symptoms. Risk-of-bias was variable.

Conclusion: Current treatments may be effective for AN but not for comorbid OCD symptoms. More research is needed examining comorbid AN and OCD treatment, particularly with more severe OCD. Future efforts should investigate transdiagnostic treatments, utilisation of OCD treatments for AN and longitudinal designs to examine relapse in addition to remission.