International Journal of Psychiatry in Clinical Practice最新文献

The study aimed to investigate the determinants associated with readmission in first-hospitalised major depressive disorder (MDD) patients with suicide attempts. The study included a cohort of 3977 patients diagnosed with MDD, as retrieved from the hospital information system (HIS). The data were split into a training set and a validation set using R software. To develop a stepwise regression model, the multivariate logistic analysis included significant factors (p threshold <0.2 in univariate analysis).(1) There was a significant difference in the incidence of readmission between first-hospitalised MDD patients with suicide attempts and those without; (2) Length of stay, course of disease, somatic symptoms, psychosis symptoms, anxiety symptoms, alcohol/tobacco dependence, family history of psychiatric disease, continued use of antidepressants combined with antipsychotics or not after discharge, and total bilirubin (TBIL) were included in these variables to build a predictive model in R software; (3) The area under the curve (AUC) was 0.783 for the training set and 0.778 for the validation set. The Hosmer-Lemesho (H-L) test for calibration was p = 0.3521 for the training set and p = 0.8497 for the validation set. The study revealed a significantly increased risk of readmission in first-hospitalised MDD patients with suicide attempts compared to their counterparts.

Introduction: Psychotropic drugs are commonly employed in the treatment of various psychiatric disorders, yet they carry a number of risks due to their potential side effects and interactions with other drugs. Some medical errors in the prescribing of psychotropic medication may have adverse consequences for patients, which may result in physical harm or even death. The objective of this study is to define the processes to be considered by investigating medical malpractice claims related to psychotropic drug treatment.

Method: A retrospective examination was conducted of the sociodemographic and clinical characteristics of medical malpractice cases alleged and reported by the relevant boards of the Turkish Council of Forensic Medicine (2nd Specialised Board, 7th Specialised Board, 8th Specialised Board, and 3rd Supreme Board) between 2013 and 2022.

Results: The majority of cases were male (72%), with an average age of 33.10 ± 16.63 years. The most common diagnosis was schizophrenia (28%), and the most frequent malpractice claims involved the effects of antipsychotic medications (50%). The most common side effects leading to claims were cardiac side effects (34%) in cases that resulted in death (p < 0.001) and extrapyramidal system side effects in other cases (14%) (p < 0.001). It was observed that 29 cases (58%) resulted in death. Antidepressants were more often claimed for causing deaths (p = 0.045), while mood stabilisers were more often claimed for resulting in injuries (p = 0.039). In 81% of non-fatal cases, the clinical side effect in question was determined to be related to the treatment (p = 0.002) and was managed appropriately as a complication (p < 0.001).

Conclusion: Psychotropic drugs can carry serious risks, especially cardiac and extrapyramidal side effects. Careful monitoring and management of these medicines are essential for patient outcomes and safety. These side effects may lead to medical error claims in some cases; however, when managed correctly, they are not considered malpractice.

Objective: The aim of this study was to determine the effects of anxiety levels and emotion dysregulation on each other and their effects on psychosocial functioning in remitted BD patients.

Methods: Sixty-six patients with BD and 38 healthy controls were included in this study. All the patients were assessed with the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Bipolar Disorder Functioning Questionnaire, the State-Trait Anxiety Inventory (STAI) and the Difficulties in Emotion Regulation Scale (DERS). Healthy controls were only assessed with the STAI and the DERS.

Results: STAI and DERS scores were significantly higher in the patient group than in the control group. Higher scores of STAI and DERS were found to be associated with lower functionality in the patient group. The trait anxiety scores explained 22% of the variance in the psychosocial functionality scores of the patients while the total DERS score explained 51.5% of the variance in the trait anxiety scores. Patients on lithium treatment had less difficulty in regulating their emotions than those on valproic acid treatment.

Conclusions: In light of these findings, planning interventions for emotion regulation difficulties during the management of patients would reduce anxiety levels and contribute to improving patients' psychosocial functionality.

Objective: The aim of this study was to compare adolescents with disruptive mood dysregulation disorder (DMDD) and comorbid attention deficit hyperactivity disorder (ADHD) and healthy control adolescents in terms of emotional intelligence (EI), emotion regulation (ER) and theory of mind (ToM) abilities.

Methods: Twenty-eight adolescents with DMDD and ADHD formed the DMDD group were compared to 31 healthy controls. We administered the Affective Reactivity Index (ARI), Difficulties in Emotion Regulation Scale (DERS), Kiddie-SADS, Bar-On Emotional Intelligence Test, Faux Pas, Comprehension Test, Unexpected Outcomes Test, Faces Test and Reading Mind in the Eyes Test (RMET) as ToM skills.

Results: ARI and DERS scores were significantly elevated in the DMDD-ADHD group. The DMDD-ADHD group had significantly lower ToM skills and emotional intelligence (p < .05). When RMET, Bar-On Emotional Intelligence Test -general mood, DERS- impulsivity scores were compared between the groups, their effect sizes were as follows: 0.52, 0.81, 0.79, respectively. DERS, emotional intelligence and ToM scores were correlated in the DMDD group. In the linear regression analysis, the sole significant predictors of self-reported irritability were EI and ED total scores.

Conclusions: This study suggests that adolescents with DMDD and ADHD face difficulties in peer relationships, mentalizing, various domains of emotional intelligence andregulation. .

Objective: Cognitive Reactivity (CR) is the (re-)activation of negative cognitions by dysphoric mood. We examined whether CR predicts depressive episodes across 2 and 9 years, beyond subclinical depressive symptoms, neuroticism, and previous depressive episodes.

Methods: Participants (N = 1,734) from the Netherlands Study of Depression and Anxiety (NESDA) were never-depressed or remitted-depressed for ≥1 month prior to baseline. We examined 2-year and 9-year predictions using Cox's survival analysis and logistic regression, respectively. Two-year coefficient-based weight-points were calculated and evaluated using ROC analysis.

Results: CR was a statistically-significant predictor of two-year depressive episodes, with an odds ratio of 1.04, 95% CI (1.02-1.06), and over nine years, with an adjusted hazard ratio of 1.01, 95% CI (1.01-1.02). The influence of CR and subclinical depressive symptoms decreased as the number of episodes increased, especially in ≥ 3 past episodes. Calculated weight-points correctly predicted 33.5% of participants who developed 2-year depression, compared to a 17.8% base rate (sensitivity = .81, specificity = .66).

Conclusions: CR is a moderately strong predictor of depressive episodes across 2 and 9 years. In participants with ≥ 3 prior episodes, depression history is such a strong predictor that a ceiling effect occurs, removing any added value of other predictors.

Introduction: This study aimed to evaluate the sociodemographic factors, loss-related factors, and adult separation anxiety associated with a diagnosis of Prolonged Grief Disorder (PGD), after controlling for anxiety, depression, and perceived social support during the COVID-19 pandemic in Türkiye.

Methods: Participants (n=126) completed an online survey that included socio-demographic and loss-related information, as well as the Hospital Anxiety and Depression Scale, Prolonged Grief Disorder Scale-13, Multidimensional Scale of Perceived Social Support, and Adult Separation Anxiety Questionnaire-27.

Results: Twelve participants were diagnosed with probable PGD (9.5%). In the linear regression analysis, it was found that when the deceased person was a first-degree relative and younger in age, the presence of guilt, increased separation anxiety, and higher depression scores significantly associated with the severity of PGD.

Conclusion: Even when the pandemic is under control, it remains crucial to offer mental health services those who have lost a loved one during the COVID-19 outbreak.

Objective: Efficacy and safety of transcranial direct current stimulation (tDCS) in the treatment of obsessive-compulsive disorder (OCD) were explored by meta-analysis.

Method: Four electronic databases (Cochrane, PubMed, Embase, Web of Science) were retrieved at 25/06/23. From our inclusion criteria, seven studies (N = 201 patients) were included, and we performed a meta-analysis using Stata15.0.

Results: Results suggested that the total Y-BOCS (Yale-Brown obsessive com-pulsive scale) scale was significantly lower in patients with OCD after tDCS treatment [SMD= -0.46, 95%CI (-0.84, -0.07), I²=39%, p = 0.02, Grade: high]. Subgroup analysis showed statistically significant results when treatment duration ≤ 20 days [SMD= -0.95, 95%CI (-1.80, -0.10), p = 0.03]. Moreover, tDCS and sham tDCS-treated OCD patients showed neither significantly different depressive symptoms nor significantly different adverse events [RR= -0.21, 95%CI (-0.58, 0.15), p = 0.25, Grade: moderate] and [RR = 3.98, 95%CI (0.04, 374.99), p = 0.55, Grade: very low], respectively.

Conclusion: tDCS maybe reduce the Y-BOCS total scores in OCD patients and depressive symptoms, but for adverse reactions. the results are inconclusive.

Objective: Sex differences have been suggested in both schizophrenia (SCZ) and autism spectrum disorder (ASD). This study aims to assess the prevalence and clinical correlates of autistic features in male and female patients with chronic SCZ.

Methods: A total of 1690 chronic SCZ patients (M/F: 1122/568) were recruited from ten psychiatric hospitals in China. The Positive and Negative Syndrome Scale Autism Severity Score and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were utilised to assess the presence of autistic features and measure cognitive function, respectively.

Results: Female SCZ patients had a higher prevalence of autistic features than male SCZ patients. In male patients, those with autistic features exhibited higher illness duration and RBANS scores, but lower years of education. Whereas in female patients, those with autistic features had higher RBANS scores, but lower years of education. Binary logistic regression analysis revealed that years of education, illness duration, visuospatial/constructional abilities, and language were correlated with autistic features in male patients. In female patients, years of education, language, and delayed memory were correlated with the presence of autistic features.

Conclusions: Our findings suggest that sex differences exist in the prevalence and clinical correlates of autistic features in chronic SCZ patients.

The use of electroconvulsive therapy (ECT) during twin pregnancy has been insufficiently studied, and there is limited evidence regarding its safety. Here, we present a case of successful use of ECT for severe major depressive disorder during twin pregnancy. The patient suffers from psychotic depression with catatonic presentation and Cotard syndrome (delusions with denial of internal organs). This case illustrates the difficulty in managing severe antenatal depression and addresses the guidelines for the ECT protocol (anaesthetic modalities, obstetrical monitoring, and duration of treatment) during twin pregnancy.

Introduction: Many studies have reported that psychiatric disorders may be associated with oxytocin receptor (OXTR) gene polymorphisms. The aim of this study was to investigate whether there is a relationship between OXTR gene polymorphisms and bipolar disorder (BPD).

Methods: The study included 100 patients diagnosed with BPD type 1 (BPD I) and 96 healthy controls. Single nucleotide polymorphisms (SNPs) of the OXTR gene, including rs53576, rs2254298 and rs2268494, were examined via polymerase chain reaction in blood samples taken from the study participants. Based on the BPD determinants, the patients were divided into 4 subgroups, as those with psychotic features, seasonal patterns, rapid cycling and peripartum onset.

Results: The frequency of the rs2268494 A allele was lower in the patients than in the healthy controls (p = .048), that frequency of psychotic mania was higher in patients with the rs53576 GG genotype compared to the A allele carriers (p = .003), and that of the seasonal pattern was higher in those carrying the rs2268494 A allele compared to those carrying the rs2268494 TT genotype (p < .001).

Conclusion: OXTR gene polymorphisms may be associated with several clinical determinants of BPD. Multicentre studies involving more subjects are required to verify these findings.