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Synaptic Density in Early Stages of Psychosis and Clinical High Risk 精神病早期和临床高危人群的突触密度
IF 25.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-13 DOI: 10.1001/jamapsychiatry.2024.3608
M. Belen Blasco, Kankana Nisha Aji, Christian Ramos-Jiménez, Ilana Ruth Leppert, Christine Lucas Tardif, Johan Cohen, Pablo M. Rusjan, Romina Mizrahi
ImportanceSynaptic dysfunction is involved in schizophrenia pathophysiology. However, whether in vivo synaptic density is reduced in early stages of psychosis, including its high-risk states, remains unclear.ObjectiveTo investigate whether synaptic density (synaptic vesicle glycoprotein 2A [SV2A] binding potential) is reduced in first-episode psychosis (FEP) and in clinical high risk (CHR) and investigate the effect of cannabis use on synaptic density and examine its relationship with psychotic symptoms and gray matter microstructure across groups.Design, Setting, and ParticipantsThis cross-sectional study was performed in a tertiary care psychiatric hospital from July 2021 to October 2023. Participants were patients with antipsychotic-free or minimally exposed FEP or CHR and healthy controls with a clean urine drug screen (except cannabis).Main Outcomes and MeasuresSynaptic density was quantified with dynamic 90-minute [<jats:sup>18</jats:sup>F]SynVesT-1 positron emission tomography (PET) scans across prioritized brain regions of interest (ROIs) delineated in individual magnetic resonance images (MRIs). Cannabis use was confirmed with urine drug screens. Gray matter microstructure was assessed using diffusion-weighted MRI to estimate neurite density.ResultsA total of 49 participants were included, including 16 patients with FEP (mean [SD] age, 26.1 [4.6] years; 9 males and 7 females), 17 patients at CHR (mean [SD] age, 21.2 [3.5] years; 8 males and 9 females), and 16 healthy controls (mean [SD] age, 23.4 [3.6] years; 7 males and 9 females). Synaptic density was significantly different between groups (<jats:italic>F</jats:italic><jats:sub>2,273</jats:sub> = 4.02, <jats:italic>P</jats:italic> = .02, Cohen <jats:italic>F</jats:italic> = 0.17; ROI: <jats:italic>F</jats:italic><jats:sub>5,273</jats:sub> = 360.18, <jats:italic>P</jats:italic> &amp;lt; .01, Cohen <jats:italic>F</jats:italic> = 2.55) with a group × ROI interaction (<jats:italic>F</jats:italic><jats:sub>10,273</jats:sub> = 2.67, <jats:italic>P</jats:italic> &amp;lt; .01, Cohen <jats:italic>F</jats:italic> = 0.32). Synaptic density was lower in cannabis users (<jats:italic>F</jats:italic><jats:sub>1,272</jats:sub> = 5.31, <jats:italic>P</jats:italic> = .02, Cohen <jats:italic>F</jats:italic> = 0.14). Lower synaptic density across groups was associated with more negative symptoms (Positive and Negative Syndrome Scale negative scores: <jats:italic>F</jats:italic><jats:sub>1,81</jats:sub> = 4.31, <jats:italic>P</jats:italic> = .04, Cohen <jats:italic>F</jats:italic> = 0.23; Scale of Psychosis-Risk Symptoms negative scores: <jats:italic>F</jats:italic><jats:sub>1,90</jats:sub> = 4.12, <jats:italic>P</jats:italic> = .04, Cohen <jats:italic>F</jats:italic> = 0.21). SV2A binding potential was significantly associated with neurite density index (<jats:italic>F</jats:italic><jats:sub>1,138</jats:sub> = 6.76, <jats:italic>P</jats:italic> = .01, Cohen <jats:italic>F</jats:italic> = 0.22).Con
重要性突触功能障碍与精神分裂症的病理生理学有关。目的 研究首发精神病(FEP)和临床高危精神病(CHR)患者的突触密度(突触小泡糖蛋白 2A [SV2A] 结合电位)是否降低,调查使用大麻对突触密度的影响,并研究其与各组精神病症状和灰质微结构的关系。这项横断面研究于 2021 年 7 月至 2023 年 10 月在一家三级精神病医院进行。主要结果和测量突触密度采用 90 分钟动态[18F]SynVesT-1 正电子发射断层扫描(PET)进行量化,扫描范围为单个磁共振图像(MRI)中划定的优先大脑感兴趣区(ROI)。通过尿液药物筛查确认是否吸食大麻。结果 共纳入 49 名参与者,包括 16 名 FEP 患者(平均 [SD] 年龄 26.1 [4.6] 岁;男性 9 名,女性 7 名)、17 名 CHR 患者(平均 [SD] 年龄 21.2 [3.5] 岁;男性 8 名,女性 9 名)和 16 名健康对照组(平均 [SD] 年龄 23.4 [3.6] 岁;男性 7 名,女性 9 名)。突触密度在组间存在明显差异(F2,273 = 4.02,P = .02,Cohen F = 0.17;ROI:F5,273 = 360.18,P &p;amp;lt; .01,Cohen F = 2.55),组与 ROI 之间存在交互作用(F10,273 = 2.67,P &p;amp;lt; .01,Cohen F = 0.32)。大麻使用者的突触密度较低(F1,272 = 5.31,P = .02,Cohen F = 0.14)。各组较低的突触密度与较多的负面症状有关(正负综合征量表负分:F1,81 = 4.31,Cohen F = 0.32):F1,81 = 4.31,P = .04,Cohen F = 0.23;Scale of Psychosis-Risk Symptoms negative scores:F1,90 = 4.12,P = .04,Cohen F = 0.21)。SV2A 结合电位与神经元密度指数显著相关(F1,138 = 6.76,P = .01,Cohen F = 0.22)。SV2A 对精神病和慢性精神障碍患者的阴性症状的影响值得进一步研究。未来的研究应纵向调查使用大麻对 CHR 中突触密度的影响。
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引用次数: 0
Inflammatory Biomarkers and Risk of Psychiatric Disorders. 炎症生物标志物与精神疾病风险
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2185
Yu Zeng, Charilaos Chourpiliadis, Niklas Hammar, Christina Seitz, Unnur A Valdimarsdóttir, Fang Fang, Huan Song, Dang Wei

Importance: Individuals with psychiatric disorders have been reported to have elevated levels of inflammatory biomarkers, and prospective evidence is limited regarding the association between inflammatory biomarkers and subsequent psychiatric disorders risk.

Objective: To assess the associations between inflammation biomarkers and subsequent psychiatric disorders risk.

Design, setting, and participants: This was a prospective cohort study including individuals from the Swedish Apolipoprotein Mortality Risk (AMORIS) cohort, with no prior psychiatric diagnoses and having a measurement of at least 1 inflammatory biomarker. Data from the UK Biobank were used for validation. Longitudinal trajectories of studied biomarkers were visualized before diagnosis of psychiatric disorders in the AMORIS cohort via a nested case-control study. In addition, genetic correlation and mendelian randomization (MR) analyses were conducted to determine the genetic overlap and causality of the studied associations using publicly available GWAS summary statistics.

Exposures: Inflammatory biomarkers, eg, leukocytes, haptoglobin, immunoglobulin G (IgG), C-reactive protein (CRP), platelets, or albumin.

Main outcomes and measures: Any psychiatric disorder or specific psychiatric disorder (ie, depression, anxiety, and stress-related disorders) was identified through the International Statistical Classification of Diseases, Eighth, Ninth, and Tenth Revision codes.

Results: Among the 585 279 individuals (mean [SD] age, 45.5 [14.9] years; 306 784 male [52.4%]) in the AMORIS cohort, individuals with a higher than median level of leukocytes (hazard ratio [HR], 1.11; 95% CI, 1.09-1.14), haptoglobin (HR, 1.13; 95% CI, 1.12-1.14), or CRP (HR, 1.02; 95% CI, 1.00-1.04) had an elevated associated risk of any psychiatric disorders. In contrast, we found an inverse association for IgG level (HR, 0.92; 95% CI, 0.89-0.94). The estimates were comparable for depression, anxiety, and stress-related disorders, specifically, and these results were largely validated in the UK Biobank (n = 485 620). Analyses of trajectories revealed that individuals with psychiatric disorders had higher levels of leukocytes and haptoglobin and a lower level of IgG than their controls up to 30 years before the diagnosis. The MR analysis suggested a possible causal relationship between leukocytes and depression.

Conclusions and relevance: In this cohort study, inflammatory biomarkers including leukocytes, haptoglobin, CRP, and IgG were associated with a subsequent risk of psychiatric disorders, and thus might be used for high-risk population identification. The possible causal link between leukocytes and depression supports the crucial role of inflammation in the development of psychiatric disorders.

重要性:据报道,精神障碍患者的炎症生物标志物水平升高,而关于炎症生物标志物与后续精神障碍风险之间关系的前瞻性证据却很有限:评估炎症生物标志物与后续精神障碍风险之间的关联:这是一项前瞻性队列研究,研究对象包括瑞典载脂蛋白死亡率风险(AMORIS)队列中既往未被诊断为精神病且至少测量过一种炎症生物标志物的个体。英国生物库的数据用于验证。通过巢式病例对照研究,观察了AMORIS队列中精神病诊断前所研究生物标志物的纵向轨迹。此外,还进行了遗传相关性和亡羊补牢式随机化(MR)分析,利用公开的GWAS汇总统计数据确定研究关联的遗传重叠和因果关系:炎症生物标志物,如白细胞、隐球蛋白、免疫球蛋白 G (IgG)、C 反应蛋白 (CRP)、血小板或白蛋白:任何精神障碍或特定精神障碍(即抑郁症、焦虑症和压力相关障碍)均通过《国际疾病统计分类》第八、第九和第十修订版代码进行识别:在 AMORIS 队列的 585 279 人(平均 [SD] 年龄,45.5 [14.9] 岁;306 784 名男性 [52.4%])中,白细胞水平高于中位数的人(危险比 [HR],1.11;95% CI,1.09-1.14)、高铁血红蛋白(HR,1.13;95% CI,1.12-1.14)或 CRP(HR,1.02;95% CI,1.00-1.04)高于中位数水平的个体罹患任何精神疾病的相关风险都会升高。与此相反,我们发现 IgG 水平(HR,0.92;95% CI,0.89-0.94)与此呈负相关。具体而言,抑郁症、焦虑症和压力相关疾病的估计值相当,这些结果在英国生物库(n = 485 620)中得到了很大程度的验证。轨迹分析表明,与对照组相比,精神障碍患者在确诊前30年内的白细胞和高铁血红蛋白水平较高,IgG水平较低。磁共振分析表明,白细胞与抑郁症之间可能存在因果关系:在这项队列研究中,包括白细胞、高铁血红蛋白、CRP 和 IgG 在内的炎症生物标志物与随后的精神障碍风险有关,因此可用于高危人群的识别。白细胞与抑郁症之间可能存在的因果关系支持了炎症在精神疾病发展中的关键作用。
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引用次数: 0
Informant Effect on Placebo Response in Mental Disorders. 告密者对精神障碍患者安慰剂反应的影响》(Informant Effect on Placebo Response in Mental Disorders)。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2862
Toshi A Furukawa, Pim Cuijpers
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引用次数: 0
Informant Effect on Placebo Response in Mental Disorders. 告密者对精神障碍患者安慰剂反应的影响》(Informant Effect on Placebo Response in Mental Disorders)。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2865
Natan Pereira Gosmann, Giovanni Abrahão Salum
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引用次数: 0
Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood. 青少年时期的炎症轨迹与成年后精神和心脏代谢紊乱的风险。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2193
Edward R Palmer, Isabel Morales-Muñoz, Benjamin I Perry, Steven Marwaha, Ella Warwick, Jack C Rogers, Rachel Upthegrove

Importance: Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes.

Objectives: To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood.

Design, setting, and participants: In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024.

Exposures: Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation.

Main outcomes and measures: Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score.

Results: A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years.

Conclusions and relevance: Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.

重要性:研究表明,低水平、非缓解性炎症可能会在成年后先于精神和身体疾病发生。然而,迄今为止的证据大多是横断面的,或侧重于单一疾病的结果:研究大量儿童和青少年样本中通过 C 反应蛋白(CRP)水平测量的炎症轨迹,并探讨不同的已识别轨迹与成年早期精神和相关心脏代谢健康结果之间的关联:在一项纵向队列研究中,我们使用了来自英国大型父母与子女埃文纵向研究(ALSPAC)的数据,通过潜类增长分析(LCGA)来探索不同的炎症轨迹,并通过逻辑回归来探索与心理和身体健康结果之间的关联。分析纳入了具有可测量的 CRP 数据以及相关心理和心脏代谢健康结果记录的参与者。数据分析时间为 2023 年 5 月 1 日至 2024 年 3 月 30 日:炎症通过 9 岁、15 岁和 17 岁时的 CRP 水平进行评估。LCGA用于识别不同的炎症轨迹:24岁时评估的结果包括精神病性障碍、抑郁性障碍、焦虑性障碍、躁狂症,以及作为胰岛素抵抗测量指标的稳态模型评估(HOMA2)得分:共纳入了 6556 名参与者(3303 人[50.4%]为女性)。炎症分为三类:CRP水平持续偏低(参考类,n = 6109);CRP水平持续升高,在9岁时达到峰值(早期峰值,n = 197);CRP水平持续升高,在17岁时达到峰值(晚期峰值,n = 250)。与 CRP 持续偏低的参与者相比,早期峰值组的参与者患精神病性障碍的风险更高(几率比 [OR],4.60;95% CI,1.81-11.70;P = .008),患严重抑郁症的风险更高(OR,4.37;95% CI,1.64-11.63;P = .02),HOMA2 评分更高(β = 0.05;95% CI,0.01-0.62,P = .04)。晚高峰组与24岁时的任何结果都无关:在儿童期达到峰值的低水平全身性炎症与青年期的特定精神和心脏代谢紊乱有关。这些研究结果表明,生命早期的低度持续炎症可能是导致精神和身体并发症的重要共同因素,因此可能与未来的患者分层和风险分析工作相关。
{"title":"Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood.","authors":"Edward R Palmer, Isabel Morales-Muñoz, Benjamin I Perry, Steven Marwaha, Ella Warwick, Jack C Rogers, Rachel Upthegrove","doi":"10.1001/jamapsychiatry.2024.2193","DOIUrl":"10.1001/jamapsychiatry.2024.2193","url":null,"abstract":"<p><strong>Importance: </strong>Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes.</p><p><strong>Objectives: </strong>To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood.</p><p><strong>Design, setting, and participants: </strong>In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024.</p><p><strong>Exposures: </strong>Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation.</p><p><strong>Main outcomes and measures: </strong>Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score.</p><p><strong>Results: </strong>A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years.</p><p><strong>Conclusions and relevance: </strong>Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1130-1137"},"PeriodicalIF":22.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Commercial Interests and EEG Data Collection. 商业利益与脑电图数据收集。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2558
Dost Ongur
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引用次数: 0
Bringing Imaging Biomarkers Into Clinical Reality in Psychiatry. 将成像生物标志物应用于精神病学的临床实践。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2553
Amit Etkin, Daniel H Mathalon

Importance: Advancing precision psychiatry, where treatments are based on an individual's biology rather than solely their clinical presentation, requires attention to several key attributes for any candidate biomarker. These include test-retest reliability, sensitivity to relevant neurophysiology, cost-effectiveness, and scalability. Unfortunately, these issues have not been systematically addressed by biomarker development efforts that use common neuroimaging tools like magnetic resonance imaging (MRI) and electroencephalography (EEG). Here, the critical barriers that neuroimaging methods will need to overcome to achieve clinical relevance in the near to intermediate term are examined.

Observations: Reliability is often overlooked, which together with sensitivity to key aspects of neurophysiology and replicated predictive utility, favors EEG-based methods. The principal barrier for EEG has been the lack of large-scale data collection among multisite psychiatric consortia. By contrast, despite its high reliability, structural MRI has not demonstrated clinical utility in psychiatry, which may be due to its limited sensitivity to psychiatry-relevant neurophysiology. Given the prevalence of structural MRIs, establishment of a compelling clinical use case remains its principal barrier. By contrast, low reliability and difficulty in standardizing collection are the principal barriers for functional MRI, along with the need for demonstration that its superior spatial resolution over EEG and ability to directly image subcortical regions in fact provide unique clinical value. Often missing, moreover, is consideration of how these various scientific issues can be balanced against practical economic realities of psychiatric health care delivery today, for which embedding economic modeling into biomarker development efforts may help direct research efforts.

Conclusions and relevance: EEG seems most ripe for near- to intermediate-term clinical impact, especially considering its scalability and cost-effectiveness. Recent efforts to broaden its collection, as well as development of low-cost turnkey systems, suggest a promising pathway by which neuroimaging can impact clinical care. Continued MRI research focused on its key barriers may hold promise for longer-horizon utility.

重要性:推进精准精神病学,即根据个体的生物学特征而非单纯的临床表现进行治疗,需要关注任何候选生物标记物的几个关键属性。其中包括测试重复可靠性、对相关神经生理学的敏感性、成本效益和可扩展性。遗憾的是,使用磁共振成像(MRI)和脑电图(EEG)等常见神经成像工具的生物标记物开发工作尚未系统地解决这些问题。在此,我们将探讨神经成像方法需要克服的关键障碍,以便在近期到中期内实现临床相关性:可靠性经常被忽视,再加上对神经生理学关键方面的敏感性和可重复的预测效用,基于脑电图的方法更受青睐。脑电图的主要障碍是缺乏多地点精神病学联盟的大规模数据收集。相比之下,尽管结构磁共振成像具有很高的可靠性,但它在精神病学中并未显示出临床实用性,这可能是由于它对精神病学相关神经生理学的敏感性有限。鉴于结构磁共振成像的普遍性,建立一个令人信服的临床用例仍然是其主要障碍。相比之下,可靠性低和难以标准化采集是功能磁共振成像的主要障碍,同时还需要证明其优于脑电图的空间分辨率和直接成像皮层下区域的能力确实具有独特的临床价值。此外,如何平衡这些科学问题与当今精神科医疗保健服务的实际经济现实之间的关系往往是一个缺失,为此,在生物标记物开发工作中嵌入经济建模可能有助于指导研究工作:特别是考虑到脑电图的可扩展性和成本效益,脑电图对近期和中期临床影响的时机似乎最为成熟。最近为扩大其收集范围所做的努力以及低成本交钥匙系统的开发,都表明神经成像技术是影响临床治疗的一条大有可为的途径。针对其关键障碍继续开展核磁共振成像研究可能会带来更长远的应用前景。
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引用次数: 0
Informant Effect on Placebo Response in Mental Disorders-Reply. 精神障碍患者对安慰剂反应的知情者效应--回复。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2868
Tom Bschor, Christopher Baethge
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引用次数: 0
JAMA Psychiatry. 美国医学会精神病学杂志》。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2023.3948
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引用次数: 0
Mental Health Care Support in Rural India: A Cluster Randomized Clinical Trial. 印度农村地区的心理保健支持:集群随机临床试验。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-01 DOI: 10.1001/jamapsychiatry.2024.2305
Pallab K Maulik, Mercian Daniel, Siddhardha Devarapalli, Sudha Kallakuri, Amanpreet Kaur, Arpita Ghosh, Laurent Billot, Ankita Mukherjee, Rajesh Sagar, Sashi Kant, Susmita Chatterjee, Beverley M Essue, Usha Raman, Devarsetty Praveen, Graham Thornicroft, Shekhar Saxena, Anushka Patel, David Peiris
<p><strong>Importance: </strong>More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas.</p><p><strong>Objective: </strong>To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health-related stigma among adults residing in rural India.</p><p><strong>Design, setting, and participants: </strong>This parallel, cluster randomized, usual care-controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire-9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder-7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023.</p><p><strong>Interventions: </strong>The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization.</p><p><strong>Main outcomes and measures: </strong>The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non-high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale.</p><p><strong>Results: </strong>Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, -1.71; 95% CI, -2.53 to -0.89; P < .001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P = .001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, -0.35; 95% CI, -1.11 to 0.41; P = .36).</p><p><strong>Conclusions and relevance: </strong>A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness.</p><p><strong>Trial registration: </strong>Clinica
重要性印度有 1.5 亿多人需要心理健康护理,但很少有人能获得负担得起的护理,尤其是在农村地区:目的:确定涉及数字医疗模式的多方面干预措施以及基于社区的反污名化运动是否能降低印度农村成年人的抑郁风险并减少与心理健康相关的污名化:这项平行、分组随机、常规护理对照试验于 2020 年 9 月至 2021 年 12 月在印度哈里亚纳邦和安得拉邦 3 个地区的 44 个农村初级保健中心进行,并在 3、6 和 12 个月时进行盲法随访评估。患者健康问卷-9(PHQ-9)项目得分达到或超过 10 分,广泛性焦虑症-7(GAD-7)项目得分达到或超过 10 分,或 PHQ-9 中自残/自杀风险问题得分达到或超过 2 分,即为抑郁症或自残高风险 18 岁及以上成年人。从剩余的筛查人群中随机抽取了第二批非高风险成人。从 2022 年 4 月至 2023 年 2 月对数据进行清理和分析:为期 12 个月的干预措施包括一项由所有参与者参与的社区反污名化运动和一项仅由高风险参与者参与的数字心理健康干预措施。对初级卫生保健工作者进行了培训,以使用世界卫生组织的心理健康差距行动方案指南来识别和管理高风险参与者:在 12 个月内评估的 2 项主要结果是高风险人群的 PHQ-9 平均得分,以及高风险和非高风险人群使用心理健康知识、态度和行为量表的平均行为得分:共招募了 9928 名参与者(高危 3365 人,非高危 6563 人;女性 5638 人 [57%],男性 4290 人 [43%];平均 [SD] 年龄 43 [16] 岁),其中 9057 人(91.2%)接受了 12 个月的随访。干预组与对照组相比,高危人群在 12 个月后的 PHQ-9 平均得分较低(2.77 vs 4.48;平均差异,-1.71;95% CI,-2.53 to -0.89;P 结论及意义:多方面干预能有效降低抑郁风险,但并不能改善精神疾病的预期求助行为:印度临床试验注册中心:CTRI/2018/08/015355.
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JAMA Psychiatry
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