International Journal of Psychiatry in Clinical Practice最新文献

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.

Background: Non-response to treatment is a major problem in Major Depressive Disorder. The identification of predictors of poor outcome could improve treatment strategies. Overall baseline severity is one of the strongest predictors, but the specific symptoms profile is poorly investigated.

Methods: Baseline symptoms scores of 1533 depressed patients were assessed through the 30-item Inventory for Depressive Symptomatology, Clinician-rated (IDS-C₃₀), as part of the Sequenced treatment alternatives to relieve depression (STAR*D) trial. Treatment outcomes were assessed after treatment with citalopram. We tested IDS-C₃₀ individual items associated with non-response in the whole sample and sex-stratified subgroups.

Results: Sadness, sleep disturbances and lassitude were predictors of outcome in the whole sample. Females showed higher scores at many somatic domains (i.e., aches and pain), the latter relating to poor outcome. Anhedonic features, albeit with sex-specific differences, were associated with poor outcome across all study groups, along with depression severity and suicidal thoughts.

Conclusions: Our findings further refine the observation that specific baseline symptomatology profiles are related to poor response in depressed individuals. This finding may inform at a clinical level for personalised treatment. The sex-specific differences suggest a thorough assessment of depressive features at the very first approach with the depressed patient.

Keypoints: Sadness, sleep disturbances and reduced energy are strong predictors of poor outcome in depressed individualsSomatic complaints may be stronger predictors among females compared to malesAnhedonic features relate to non-response.

Objective: The present study evaluate the presence of subthreshold autistic traits, assess the level of body image dissatisfaction, and explore their potential association in female patients with eating disorders.

Method: The study used the Adult Autism Subthreshold Spectrum - AdAS and the Body Uneasiness Test - BUT to identify autistic traits that predict body image distress, applying linear and stepwise regression.

Results: The sample consisted of 49 female patients with eating disorders with a mean duration of illness of 4 years. Regression analysis indicated that BUT 'Weight Phobia' factor was positively associated with AdAS 'Non-Verbal communication' and 'Inflexibility and adherence to routine' domains, BUT 'Body Image Concerns' factor was associated with AdAS 'Non-Verbal communication' and 'Inflexibility and adherence to routine' domains. BUT 'Compulsive Self-Monitoring' factor was associated with AdAS 'Inflexibility and adherence to routine' domain and, finally BUT 'Depersonalization' factor was positively associated with AdAS 'Hyper- and hypo reactivity to sensory input'. The average AdAS score is 73.8 (± SD 22.8).

Conclusions: The study highlights that subthreshold autistic traits may play a role in altering body image in patients with eating disorders, possibly due to altered sensory perception. Further research is needed to explore causes and therapies.

Objective: The study aims to investigate the prevalence of general medical conditions (GMCs) within a sample of adult with Attention Deficit Hyperactivity Disorder (ADHD) and to ascertain whether such comorbidities may correlate with specific socio-demographic or clinical parameters.

Methods: The sample included 196 outpatients with adult ADHD. Binary logistic regression (LogReg) was used to identify explanatory variables associated with GMC.

Results: Ninety-four subjects (48%) had at least one GMC. ADHD patients with GMCs showed more psychiatric family history (56.7% vs 30.9%), more comorbidities with bipolar spectrum disorders (17% vs 5.9%), and greater impairment in social functioning (67% vs 52.9%). At the LogReg analysis, only the association with psychiatric family history and comorbidity with bipolar disorder remained significant.

Conclusions: We observed a high prevalence of GMC among adult ADHD outpatients. The association found between GMC and a family history of psychiatric disorders allows to hypothesise that there may be a genetic predisposition substrate to both GMC and psychiatric disorders, while the association between GMC and comorbidity with bipolar spectrum disorders can be explained by the tendency of bipolar disorder itself to be associated with GMC. It appears crucial in these patients to perform routine medical examinations and to implement a healthy lifestyle.

Objective: This study compared clinical features, symptom severity, and prenatal/perinatal risk factors in children with regressive (ASD-R) and non-regressive autism spectrum disorder (ASD-NR) in a Turkish paediatric sample.

Method: A retrospective cross-sectional study was conducted with 143 children aged 2-6 years diagnosed with ASD, grouped as ASD-R (n = 29) or ASD-NR (n = 114). Symptom severity was assessed using the CARS, AuBC, and ABC. Data on prenatal and perinatal factors, epilepsy, and parental age were collected.

Results: No significant differences were found in CARS, AuBC, or total ABC scores, except for higher lethargy/social withdrawal scores in the ASD-NR group. Prenatal and perinatal risk factors and epilepsy prevalence were similar. However, parental ages at birth were significantly higher in the ASD-R group. Logistic regression did not yield significant predictors of regression.

Conclusion: The findings suggest that prenatal and perinatal factors may influence developmental regression in ASD when interacting with genetic vulnerability. Longitudinal studies are needed to clarify the role of early environmental exposures and epigenetic mechanisms in regression patterns.

Objective: Loneliness can be defined as a subjective distressing experience that results from perceived isolation or the difference between an individual's preferred and actual social experience. Loneliness is associated with an increase in the incidence of psychiatric and medical disorders and suicidal behaviour. The goal of this article is to attract attention to underappreciated issues of loneliness in veterans and suicidality in lonely veterans.

Methods: A review of the relevant literature.

Results: Military veterans have unique experiences of loneliness, especially older veterans. Suicide in veterans is a major social issue. Studies suggest that loneliness may contribute to suicidality among veterans. Loneliness is a transdiagnostic suicide prevention and intervention target in the veteran population.

Conclusions: Prevention of suicide in lonely veterans should include six components: (1) Recognition of loneliness; (2) Reduction of loneliness; (3) Management of psychiatric and medical disorders; (4) Assessment of suicide risk; (5) Restricting access to the means for suicide; and (6) Specific interventions to reduce suicidality.

Background: Quality of life (QoL) in patients with Schizophrenia has become one of the most important outcome measures in long-term treatment; however, in the Latin American context, longitudinal research that analyzes its trajectories over time and its relationship with clinical and sociodemographic aspects is still scarce. The aim of this study was to longitudinally evaluate QoL in conjunction with psychotic symptomatology, internalised stigma, social cognition, premorbid adjustment, and years of untreated psychosis in a sample of patients with a diagnosis of Schizophrenia in Northern Chile.

Method: A total of 26 patients were able to complete the 10-year follow-up of measures and predictors of stigma, which were evaluated in Public Outpatient Mental Health Centres in the city of Arica between March-July 2012 and March-July 2022. The results show that QoL trajectories improve over time, especially in aspects such as family relationships, autonomy and resilience. On the other hand, depressive symptoms, self-stigma and premorbid adjustment were significant predictors of follow-up measures of QoL.

Discussion: These results underscore the importance of overcoming stigma and depressive symptomatology to improve the QoL of patients with Schizophrenia. Also, the results yielded that premorbid successful psychosocial functioning and experiences are a significant predictor of QoL.