International Journal of Psychiatry in Clinical Practice最新文献

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.

Background: Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings.

Methods: A narrative review was conducted to identify strategies for recognizing and treating patients with SSA.

Results: The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA.

Conclusion: Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.

Background: This study aimed to provide a comprehensive synthesis of the evidence examining lipid profiles in drug-naïve MDD patients.

Materials and methods: We searched PubMed, Scopus, and ISI Web of Science up to August 2023 for total cholesterol, HDL-C, LDL-C, and triglyceride levels in drug-naïve MDD patients.

Results: A total of 17 articles comprising 2174 individuals including drug-naïve MDD subjects and controls were included. Our results showed that concentrations of total cholesterol were lower in drug-naïve MDD patients compared with healthy controls (SMD -0.49, 95% CI -0.881 to -0.105; p = 0.015; I2 = 90.6%). However, comparison of other lipid levels between MDD patients and healthy controls demonstrated no significant difference. The results revealed that the association of total cholesterol levels with MDD is more prominent in male-dominant studies (SMD -1.20, 95% CI -2.23 to -0.18, I2 = 87.9%) than in female-dominant studies (SMD -0.25, 95% CI -0.63-0.13, I2 = 89.0%). In meta-regression, none of the factors including year of publication, Newcastle-Ottawa Scale score, sample size, BMI, and mean age of participants had a significant influence on the association between cholesterol levels and MDD.

Conclusions: Lower levels of total cholesterol, especially in males, are associated with MDD, so early lipid monitoring and targeted interventions are necessary.

Objective: Therapeutic drug monitoring (TDM) is an important tool for treatment optimisation. Its usefulness has recently been demonstrated for some first-line antidepressants; however, few studies have been reported on the relationship between blood levels of mirtazapine and its antidepressant effects. The aim of this study was to investigate the association between blood concentration of mirtazapine and antidepressant response.

Methods: 59 outpatients treated with mirtazapine for depression were recruited and followed up for three months in a naturalistic setting. Hamilton Depression Rating Scale-21 (HAMD-21) was administered at baseline, month 1, and month 3 to assess antidepressant response. Mirtazapine serum concentration was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between serum concentration of mirtazapine and antidepressant response.

Results: Our results showed no overall association between serum concentration of mirtazapine and symptom improvement at month 1 and month 3. A marginally significantly higher serum concentration of mirtazapine was found in responders vs non-responders at month 3.

Conclusions: The study suggests that serum concentration of mirtazapine is not strongly associated with the antidepressant efficacy of mirtazapine. This is probably attributed to its pharmacodynamic profile, even though higher blood levels seem to be marginally more effective.

Background: We report a case on the efficiency of low-frequency repetitive transcranial magnetic stimulation (rTMS) on cigarette consumption cessation.The patient was 29 years old, He received intensive psychiatric treatments along with ten years of history of depressive and obsessive-compulsive disorders.The first four years of treatment were marked by good outcomes. However, the last 6 years were marked by persisting depressive symptoms associating with psychotic features and sexual obsessions.

Methods: The patient received 20 sessions of rTMS over two weeks, 10 times per week at 1 Hz frequency, each session lasted 20 min with 200 pulses and 100% of motor threshold. In the meanwhile, the patient continued his full drug-based treatment according to the reported prescription.

Results and conclusion: After 20 sessions, the patient reported a decreased severity of his depressive symptoms with a BDI (Beck Depression Inventory) score of 6 but without significant improvement of OCD with a YBOCS score of 32. However, the patient reported great improvement in his tobacco craving and a diminishing number of consumed cigarettes in the second week of the rTMS protocol of treatment. This ended with tobacco cessation within a month. However, this occurred without any medication or psychological support for treating tobacco dependence.

Background: Studying empathy in borderline personality disorder (BPD) is essential because difficulties with interpersonal functioning are integral.

Objectives: This scoping and narrative review explores the aetiological theory that BPD is an innate anomaly of cognitive empathy, with a normal or heightened emotional empathy.

Eligibility criteria and sources of evidence: Ovid MEDLINE(R) ALL was searched using the terms empathy; theory of mind; mentalisation or mentalising; borderline empathy; emotion recognition and BPD. For inclusion in the scoping review, articles needed to empirically assess an empathic skill in people with BPD, or self-reported empathy in a BPD group compared to controls, or empathic skill as a 'borderline feature' in a nonclinical sample.

Charting method: The results of empirical studies were categorised as per their methodological approach, with results in the BPD group reported as comparable, enhanced or reduced compared to controls.

Results: 320 articles were returned, with 38 eligible. The majority affirmed that people with BPD have an anomalous empathetic ability, especially a deficient cognitive empathy. Furthermore, this is trait, evident early in development, correlates with syndrome severity, and is mediated by atypical neural networks.

Conclusions: This substantiates the theory that BPD is, at least in major part, an innate empathy anomaly.