International Journal of Psychiatry in Clinical Practice最新文献

Objective: Mitochondria are essential for energy production and reactive oxygen species (ROS) generation, with changes in ROS levels or energy demands affecting mitochondrial DNA (mtDNA) copy numbers, indicating mitochondrial function. Early life adversity (ELA) affects mitochondrial dynamics, influencing long-term health. Both ELA and mitochondrial abnormalities have been independently associated with bipolar disorder (BD). This study aims to explore the complex interplay between mitochondrial dysfunction, ELA, and BD.

Methods: The study included 60 participants diagnosed with BD and 66 healthy controls (HCs). Data were collected using the Childhood Trauma Questionnaire (CTQ), and leukocyte mtDNA copy number (MCN) was determined from blood samples.

Results: The results indicated the CTQ sum scores were significantly higher in the BD group, reflecting greater exposure to ELA. In HCs, a marginally significant nonlinear relationship between the square of the CTQ sum score and MCN was found. Further analysis demonstrated a significant interaction between ELA and BD on MCN (p = 0.023), highlighting a critical connection between ELA and mitochondrial dysfunction in BD and reinforcing its biological underpinnings.

Conclusions: Future treatments for BD might target mitochondrial dysfunctions related to chronic stress, with potential pharmaceuticals designed to address these issues and mitigate the negative effects of chronic stress.

Objectives: Research on new serum parameters in bipolar disorder (BD) and schizophrenia is crucial for early diagnosis and understanding of disease pathophysiology. The arginine metabolic pathway has been found to be associated with several neuropsychiatric disorders in recent years. This study aims to investigate the role of serum markers involved in different steps of the arginine metabolic pathway in BD and schizophrenia.

Methods: Sixty healthy volunteers, sixty patients with schizophrenia and sixty patients with BD were included in the study. We analysed ornithine decarboxylase (ODC), arginine decarboxylase (ADC) and agmatinase levels using enzyme-linked immunosorbent assay. Enzymatic colorimetric methods were used for nitric oxide (NO), nitric oxide synthase (NOS) and arginase measurement.

Results: Serum agmatinase levels were significantly lower in BD and schizophrenia (p < 0.01). ODC and ADC levels were significantly lower in BD group compared to the control and schizophrenia groups (p < 0.001; p < 0.01). Serum NO levels were significantly higher and NOS levels were significantly lower in BD (p < 0.001; p < 0.05). Arginase levels were also lower in BD (p < 0.05).

Conclusions: Enzymes and substrates of the arginine metabolic pathway are promising markers in BD and schizophrenia. These markers can also be used to enable the diagnosis, when an adequate verbal communication is impossible.

Objective: The first-episode psychosis (FEP) and clinical high-risk (CHR) team within the child and adolescent mental health (CAMH) service receives referrals by psychiatric units, CAMH service, schools, and general practitioners. This audit evaluated the implementation of the FEP-CHR team in Ferrara, Italy.

Methods: The FEP-CHR team provides standardised assessment and up to 2-year individualised treatment including pharmacological prescription, cognitive-behavioral psychotherapy, and vocational activities. Data regarding access and pathways to care, assessment, and outcome of all patients admitted to this service from January 2019 to June 2023 were analysed. Descriptive statistics were reported and discussed.

Results: The service admitted 29 patients (19 FEP, 10 CHR), mostly females. FEP referrals primarily came from families via general practitioners, while half of CHR patients were already receiving CAMH care. One in three in the total sample had psychiatric hospitalisation during treatment. At discharge, most transitioned to usual or specialised mental health care and five patients achieved full recovery.

Conclusions: The audit revealed a lower-than-expected incidence rate, a sub-optimal adherence to the standardised assessment, and a need for improved outcome monitoring. It promoted quality improvement initiatives including professional training to improve psychiatric differential diagnosis, drug prescribing, and transition to adult psychiatric services.

Background: Suicide attempts have been intensively examined in chronic schizophrenia (SCZ) patients with comorbid depression. This study aimed to investigate the prevalence and clinical correlates of suicide attempts in Chinese first episode drug-naïve (FEDN) SCZ patients with comorbid severe depression.

Methods: Totally 317 FEDN SCZ patients were recruited into the study. Patients were assessed for symptoms using the 24-item Hamilton Depression Scale (HAMD₂₄), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS). Plasma glucose and lipids were measured. A score of more than 35 on the HAMD₂₄ was defined as severe depression.

Results: Suicide attempts occurred at a higher rate in patients with severe depression than in those without (33.4% vs 16.7%). Among patients with severe depression, HAMD and PANSS total score were higher in suicide attempters compared to non-attempters (all p < 0.05). PANSS total score was independently related to suicide attempts in FEDN SCZ patients who had severe depression (OR = 1.02, p < 0.05).

Conclusion: Suicide attempts are more prevalent in FEDN SCZ patients with comorbid severe depression than in those without. Psychotic symptoms might be involved in suicide attempts in FEDN SCZ patients with severe depression, while depressive symptoms might not.

Modern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in depressed patients showing non-response to two or more trials of antidepressants. Recently, large sample head-to-head comparisons of intravenous ketamine versus ECT for treatment-resistant depression (TRD) have fuelled the debate on which therapy might be more effective. However, the informative value of these studies is limited due to major methodological differences, especially regarding patients' baseline clinical characteristics and treatment procedures. This commentary, in reaction to the recently published article by Jha et al. 'Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial' in JAMA Network Open, addresses this issue and proposes that treatment decisions of ECT or ketamine should be based on substantiated, predictive clinical response markers and patient's preferences. It is undisputed that both treatments are highly effective in TRD, yet, given that ketamine is usually administered before ECT, efficacy studies of ECT in ketamine non-responders are urgently warranted.KEYPOINTSModern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in treatment-resistant depressionHead-to-head comparisons of both treatments have yielded incongruent findings due to differing patients' baseline clinical characteristics and treatment proceduresTreatment-decisions of ECT or ketamine should be based on predictive clinical response markers and patient's preferences while considering the specific side effect profiles of both optionsFuture prospective studies should assess the efficacy of ECT in ketamine non-responders.

Objective: Intensive Home Treatment (IHT) is an alternative to acute inward treatment. The objective of this study was to assess which variables predict that a patient admitted to IHT required transfer to hospital for inward management.

Methods: We included the first 1000 episodes admitted to IHT and looked for crude associations between potential predictive factors and transfer to hospital. Then, we built a predictive model for this outcome.

Results: The patients with a higher risk of transfer to hospital were those who had previous hospitalisations (OR = 2.6; 95% CI = 1.4-4.7), more admissions in the previous 5 years (median= 0, IQR = 0-1 vs. median = 0, IQR = 0-1.5; p = 0.0011) and a higher clinical severity at IHT admission (mean difference = 0.36; p50 = 0, IQR = 0-1.5 vs. p50 = 0, IQR = 0-1; p = 0.0011). The predictive model included age, previous admissions, clinical severity at IHT admission, and substance use at the beginning of the episode but had a low performance (R2 = 0.115; AUC = 0.752, 95% CI: 0.690-0.814).

Conclusion: Our results are consistent with those from previous studies in countries with different mental health systems. Far from cautioning us against using IHT in patients with severe symptoms or previous hospitalisations, these results should encourage us to find ways to offer them greater support at home.

Background: The psychiatric phenotype of the 22q11.2 deletion syndrome (22q11DS) has been largely described.

Objectives: With a case-control study design, we now compared a sample of 22q11DS patients with a psychiatric diagnosis with a sample of psychiatric patients without 22q11DS to investigate possible differences between groups for depression severity, hopelessness, and suicide. Patients with 22q11DS were divided into two groups according to the levels of hopelessness to evaluate the relationship between hopelessness and the severity of the 22q11DS, the level of disability, functional impairment, physical frailty, and autonomy level.

Results: Results showed that suicide risk evaluated with the C-SSRS was similar in the two groups of patients and that a diagnosis of 22q11DS does not appear to be a risk factor for suicide; however, 22q11DS patients had more severe hopelessness. Patients with a more severe clinical presentation and worse overall functioning have higher levels of depressive symptoms and hopelessness.

Conclusions: The results suggest the need to assess and monitor psychiatric symptoms in patients with 22q11DS.

Introduction: The controversy of antidepressant use in bipolar depression remains controversial. Agomelatine (AGO) is an effective antidepressant in major depressive disorder (MDD), but its application in bipolar depression was little discussed. We aimed to provide a comprehensive systematic review of clinical evidence from studies examining the efficacy and safety of AGO for bipolar depression.

Methods: We conducted a systematic review about AGO trials for the treatment of bipolar patients. We searched PubMed, MEDLINE, Embase, and Cochrane for relevant studies published since each database's inception. We synthesised evidence regarding efficacy (mood and rhythm) and tolerability across studies.

Results: We identified 6 studies including 272 participants (44% female). All studies used 25-50 mg AGO per day for treatment combined or not combined with mood stabilisers (MS). Across all 6 studies, there were improvements in depression evaluated by depression rating scores and response rate over time. The response rates varied from 43% to 91% within 6-12 weeks. Although AGO was found of better efficacy in bipolar depression compared to recurrent depression, its efficacy remains controversial. Most studies have shown AGO to be effective after just about a week. AGO was reasonably well tolerated both in acute and extension period, without obvious risk in inducing mood switching.

Conclusion: AGO is promising in treating bipolar depression with significant efficacy and well tolerability. However, more strictly designed and large-sample trials are needed in further research with homogeneity within intervention and treatment groups.

Objective: To evaluate the effectiveness and safety of long-term use of silexan in patients with a wide range of anxiety disorders.

Methods: A retrospective chart review was conducted on 50 patients diagnosed with various anxiety disorders who were prescribed silexan. The primary outcomes measured included the resolution of anxiety symptoms, changes in Generalized Anxiety Disorder-7 (GAD-7) scores, and Clinical Global Impressions-Improvement (CGI-I) scores. The duration of silexan use and any reported adverse events were also recorded.

Results: Silexan effectively resolved anxiety symptoms in 35 patients, with 24 out of 25 patients who received silexan for more than 12 weeks showing significant improvement. Median GAD-7 and CGI-I scores decreased significantly (p<0.001). By the end of the follow-up period, 46% of patients had minimal anxiety and 24% had mild anxiety. No adverse events were reported during the study period.

Conclusions: Long-term use of silexan is feasible, safe, and effective in managing a wide range of anxiety disorders in real-world clinical settings.

Objective: ESKALE is a French, multicentre, observational study of adults with treatment-resistant depression (TRD) treated with esketamine. This interim analysis describes baseline demographic and clinical characteristic evolution in patients included and treated from early access program to post-marketing launch.

Methods: Data were collected from medical records and included patient characteristics, disease history at esketamine initiation, use of neurostimulation, the patient's care pathway, and the number of antidepressant treatment lines prescribed prior to esketamine initiation. Descriptive statistics were used for each cohort: the early access program 'Temporary Authorisation for Use' (ATU), post-ATU, and post-launch cohorts.

Results: The overall ESKALE cohort (N = 160 included; n = 157 treated with esketamine; average age 49.0 years; 66.2% female) demonstrated moderate-to-severe depression according to clinical assessment and a mean Montgomery-Åsberg Depression Rating Scale score of 32.6 (8.0); however, severity, subtype, and comorbidities were heterogeneous across the cohorts. Earlier use of esketamine and prior to alternative treatments occurred during the later cohorts.

Conclusion: These findings demonstrated a high burden of TRD in these patients and that esketamine is used in TRD treatment regardless of their disease severity, subtype, or existing comorbidities. These results also suggest that esketamine is potentially a clinically useful alternative treatment, particularly with healthcare professionals gaining greater familiarity with and easier access to esketamine.