International Journal of Psychiatry in Clinical Practice最新文献

Background: The perceived stress scale (PSS-10) assumes that stress results from perceived situational demands exceeding the perceived coping resources. However, today's hectic lifestyles may lead to stress even when demands can be met. We aimed to assess a new measure of stress, the D-Stress scale, which focuses on feelings of relentless pressure, irrespective of the coping resources.

Methods: We administered our 10-item questionnaire to 1099 French-speaking adults (455 men, 642 women), aged 18-29 years, using an online platform (May-July 2022). Participants also completed the PSS-10 and measures of depression (PHQ-9) and anxiety (GAD-7). Exploratory and confirmatory factor analyses and correlations were run.

Results: The D-Stress scores correlated highly with the PSS-10 perceived helplessness subscale (r = 0.714; 95% CI [0.684-0.742]), thus supporting the construct validity. The exploratory factor analysis revealed three underlying factors: one that related to experiencing external pressures (subscale 1), another that related to putting pressure on oneself (subscale 2), and a third that related to exhaustion (subscale 3). Subscale 1 was most strongly linked to depression/anxiety; the other two subscales were more strongly linked to demographic characteristics.

Conclusion: The D-Stress scale can rapidly assess stress and could identify underlying sources to help target interventions.

Introduction: Non-suicidal self-injury (NSSI) is a strong predictor of increased future suicidal ideation and risk. The highest prevalence of NSSI is in adolescents. NSSI is performed as a maladaptive response to emotion regulation distress when facing an intense negative emotional load. One of the physiological markers of Emotion Dysregulation (ED) can be measured quantitatively through changes in Heart Rate Variability (HRV).

Objective: The purpose of this review is to provide an overview about studies on HRV and ED in adolescents with NSSI to shed light on potential associations and to identify prospective approaches for future studies.

Method: Literature was searched through Pubmed using Heart Rate Variability (HRV), Emotion Dysregulation (ED), and Non Suicidal Self-Injury (NSSI) as the keywords. Inclusion criteria were full-text journal articles in English or Indonesian within the last 10 years.

Results: Studies show that ED in certain mental disorders has been associated with HRV changes through the autonomic nervous system imbalance pathway. For individuals with ED, NSSI may serve certain perceived benefits, reinforcing its repetition whenever adverse events are encountered.

Conclusions: ED in adolescents with NSSI can be observed through HRV reduction. This approach may help improve adolescent mental health by reducing NSSI and preventing suicidal tendencies.

Objectives: Understanding real-life management of mental health disorders is crucial for enabling effective social and healthcare interventions. This retrospective real-world study investigated differences in the management of young adults (<30 years) and adults (≥30 years) starting treatment with second-generation antipsychotics (SGAs) in Italy, Spain and Poland.

Methods: Patients' characteristics, treatment and safety profile and healthcare resource utilisation were analysed from general practitioners' and psychiatrists' electronic medical records and from pharmacy prescription records. The main analysis was stratified by age, but stratification by SGA molecule and a focus on subjects with schizophrenia were also provided.

Results: A total of 530,587 subjects started treatment with SGAs. Throughout data sources, young adults accounted for from 17.8% to 30.2%; women were more represented among adults, who also had higher proportions of comorbid conditions. Young adults showed higher frequencies of switches (from 4.7% to 11.0% for young adults and from 2.9% to 8.6% for adults) and add-ons (from 2.5% to 5.6% for young adults and from 1.7% to 5.0% for adults) and exhibited slightly better adherence/persistence with the initial SGA.

Conclusions: Distinct management behaviours were identified depending on age. A nuanced approach integrating tailored therapeutic strategies is needed to optimise long-term outcomes for patients requiring treatment with SGAs.

Objective: To examine the relationship between depressive symptoms and daily functioning among patients with bipolar depression using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Sheehan Disability Scale (SDS).

Methods: A post-hoc analysis was conducted using data from a placebo-controlled study of lurasidone involving 399 patients with bipolar depression. Pearson's correlation coefficient was used to analyse the correlation between the MADRS and SDS total scores. Receiver operating characteristic (ROC) analysis determined the MADRS cut-off score for adequate functional improvement, defined as all SDS subscale scores ≤2.

Results: The MADRS and SDS scores were positively correlated (r = 0.764). The ROC analysis yielded a MADRS cut-off score of 15.5 for adequate functional improvement with 86.9% sensitivity and 75.9% specificity. The wide distribution of the relationship observed between symptoms and functioning indicated diversity in treatment responsiveness in bipolar depression.

Conclusions: Depressive symptoms and daily functioning are correlated; however, this relationship is not straightforward, highlighting the need for evaluating symptoms and functioning separately. Importantly, direct application of the statistical MADRS threshold in clinical practice may be inappropriate for estimating SDS-based functioning. Further research is needed to establish norms linking levels of symptoms and functioning in bipolar depression.

Background: Clinical decision-making for the pharmacological treatment of aggressive behaviour in psychiatry remains challenging. Asenapine, a second-generation antipsychotic with a higher affinity for dopamine D4 than for D2 receptors, may become a treatment option, although this remains to be demonstrated.

Methods: A systematic search was conducted across biomedical databases according to PRISMA Reporting Items for Systematic Review. We aimed to examine the efficacy and effectiveness of asenapine in the management of aggressive behaviours including psychomotor agitation, hostility, irritability, anger, impulsivity, self-harm, behavioural disinhibition, as well as physical and verbal aggression, across psychiatric disorders.

Results: Of the 12 studies included, four reported asenapine's efficacy in aggressive behaviours compared to placebo, and five described the effectiveness in uncontrolled settings. Three studies found no advantages over olanzapine. Major evidence supports asenapine's efficacy in reducing psychomotor agitation and hostility, with benefits independent of its anti-manic and antipsychotic effects.

Conclusion: Asenapine may be a viable option for the treatment of psychomotor agitation and hostility, although more head-to-head trials are needed to clarify its efficacy relative to other antipsychotics. Since the evidence of efficacy in other aggressive domains and diagnoses is still limited, clinicians should primarily consider the tolerability profile to guide their prescription.

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: The Yale Global Tic Severity Scale (YGTSS), although extensively utilised in China for evaluating tic disorders (TD), relies exclusively on clinician-administered assessments. At present, no parent-report instruments validated in the Chinese context are available for assessing tics. The Parent Tic Questionnaire (PTQ), originally developed as the first parent-rated tool for TD symptom evaluation, has yet to undergo validation in any Asian language.

Methods: A total of 414 children and adolescents aged 2-16 years with a TD diagnosis were recruited. The PTQ, YGTSS, Conners' Parent Rating Scale (CPRS-48) and Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were administered to examine the psychometric characteristics of the PTQ.

Results: Cronbach's alpha coefficients for the PTQ motor, vocal and total tic subscales were 0.789, 0.821 and 0.849, indicating satisfactory internal consistency. Strong correlations were observed between PTQ total scores and YGTSS scores. A cut-off score of 14 on the PTQ emerged as the most appropriate threshold for differentiating between mild and moderate TD. The content validity index further demonstrated high validity for the Chinese PTQ.

Conclusions: The validated Chinese version of the PTQ exhibits robust psychometric properties and provides clinically informative metrics for tic severity stratification, establishing a foundation for score standardisation in routine assessments.

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.