Journal of psychiatric research最新文献

Background: Bipolar disorder (BD) is a chronic and debilitating mental illness characterized by alternating episodes of mania and depression, affecting approximately 5-6% of the global population. Despite extensive research, the underlying pathophysiology of BD remains poorly understood, necessitating further exploration of potential biomarkers. This meta-analysis investigates peripheral levels of glial cell line-derived neurotrophic factor (GDNF) to evaluate its utility as a biomarker in individuals with BD.

Methods: We systematically searched four international databases, identifying 13 case-control studies (825 patients with BD vs. 885 healthy controls) and 4 clinical trials encompassing 153 patients with BD. The study adhered to PRISMA guidelines and employed rigorous quality assessment tools, including the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for clinical trials.

Results: The analysis revealed a pooled standardized mean difference of d = -0.81 [CI: 1.41 to -0.22], p = 0.007. However, extreme heterogeneity (I² > 96%) and publication bias preclude reliable interpretation of this estimate. Furthermore, the meta-regression analyses were significant for illness duration, YMRS score, and year of study. Subgroup analysis showed significant estimates for blood sample, mania episode, and Asian region. Although treatment interventions increased GDNF levels, these changes were not statistically significant (d = 0.12, [95% CI: 0.20 to 0.44], p = 0.463). High heterogeneity was observed across studies, indicating substantial variability in study designs and participant characteristics.

Conclusion: The literature provides preliminary, highly heterogeneous evidence suggestive of altered GDNF levels in BD, primarily within serum during mania. The plasma-serum discrepancy highlights a major methodological confounder (platelet GDNF release), and the significant heterogeneity and publication bias preclude a reliable estimate of the true effect size. GDNF cannot be considered a disorder-specific biomarker for BD, as similar alterations are reported in major depression and schizophrenia. Future research must prioritize plasma measurements, standardized protocols, and longitudinal designs in medication-naïve cohorts to clarify whether GDNF acts as a state-dependent marker of acute mood episodes within a transdiagnostic framework.

This study evaluated the feasibility, acceptability, and preliminary clinical outcomes of a time-limited, evidence-based telemental health (TMH) intervention delivered within a Graduate Student Mental Health program at a northeastern U.S. university between August 2022 and January 2023. Standard measures of depression and anxiety were collected at pre- and post-treatment and supplemented with electronic health record data for 28 participants who initiated and completed treatment. The program consisted of 12 weekly, 45-minute individual psychotherapy sessions delivered via a HIPAA-compliant virtual platform. Feasibility was assessed using enrollment and retention, and acceptability was assessed using engagement indicators, including attendance rates. Thirty-eight students initiated treatment, and 28 completed the program (73.6% retention), with an average attendance of 9.79 of 12 sessions (SD = 2.91). Significant pre-to post-treatment reductions were observed in depression scores, (M = 9.61, SD = 5.24) to M = 5.46, SD = 3.78); t (27) = 5.50, p = < .001), d = 1.04 and anxiety scores (M = 9.93, SD = 4.83) to M = 5.54, SD = 3.81); t (27) = 5.41, p = < .001), d = 1.02. These findings provide preliminary evidence that a time-limited TMH model may be a feasible and acceptable intervention for graduate students experiencing psychological distress; however, the small, self-selected, non-randomized sample and the absence of a control group limit conclusions about effectiveness and generalizability. In the context of substantial mental health needs and barriers to care in university settings, the results highlight the potential value of scalable TMH programs for expanding access to treatment among graduate students.

This study provides insights into the impact of prolonged war on suicidality, focusing specifically on suicide-related calls to Israel's national mental health helpline during the year following the October 7, 2023, Hamas terror attack and ongoing war. Utilizing data from 615,046 helpline calls between October 7, 2022, and November 2, 2024, the findings showed an immediate, significant increase in overall distress calls after the attack. Conversely, there was a notable and persistent decrease in both the proportion and total number of suicide-related calls throughout the year-long period of war. These findings align with previous research suggesting that heightened war-related distress does not necessarily lead to increased suicide risk, possibly due to factors such as increased social cohesion. Building upon our previous research, the current study contributes to the limited body of knowledge regarding suicidality patterns during prolonged wars. The study underscores the complexity of suicidality patterns during a prolonged war and emphasizes the need for ongoing monitoring and targeted mental health interventions during sustained national crises.

Background: Current treatment algorithms for major depressive disorder (MDD) lack dynamic prediction capabilities, leading to delayed therapeutic adjustments. This study sought to develop escitalopram-specific decision tree models to identify critical treatment adjustment time points and optimize personalized treatment strategies for MDD.

Methods: Using longitudinal data from two multicenter studies in China (2015-2020), we analyzed 800 patients with MDD receiving escitalopram monotherapy. Decision tree models incorporated baseline characteristics (age, BMI, disease duration, depressive symptoms) and dynamic treatment parameters (dose, 2-/4-week improvement) to predict full response (>50% symptom reduction) or non-full response (≤50% reduction) at weeks 2 and 4, and remission status (QIDS-SR16≤5 vs. >5) at week 8. Model performance was assessed by accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).

Results: The week 2 model (n = 800) identified BMI, age, disease duration, course and baseline symptom severity as primary predictors (accuracy = 61.88%, NPV = 84.04%). By week 4 (n = 650), early response status (week 2) merged as a key predictor (accuracy = 69.23%, NPV = 71.62%). The week 8 model (n = 456) demonstrated enhanced predictive power, driven by life quality score, week 2/4 response status, and week 4 dosage (accuracy = 78.02%, PPV = 81.48%, NPV = 72.97%). Logistic regression confirmed week 4 response status as a significant predictor of week 8 outcome (p < 0.005).

Conclusions: Week 4 emerges as a key decision point for escitalopram-treated MDD patients, where integration of baseline profiles, early response patterns, and dose parameters allows timely intervention. Our decision tree framework offers a methodological approach for dynamic decision points that warrant prospective validation and extension to other antidepressants.

Background: The metacognitive model of suicidality suggests that suicide-related metacognitions activate a Cognitive Attentional Syndrome (CAS)-including suicide-specific rumination, attentional fixation, and thought suppression-which may intensify and prolong suicidal ideation. While initial support has emerged from general population samples, longitudinal evidence in high-risk clinical populations remains lacking.

Methods: In a multicenter, prospective study, we examined model assumptions in a sample of 184 psychiatric inpatients (M = 37.5 years, 50% male), all admitted following a suicide attempt or severe suicidal crisis. Participants completed baseline assessments prior to discharge and engaged in a 3-week ecological momentary assessment (EMA) protocol measuring suicide-specific rumination, thought suppression, and suicidal intent up to four times daily. Past suicidal ideation and suicide-related metacognitions (positive and negative) were assessed using validated scales.

Results: Past suicidal ideation significantly predicted both positive and negative suicide-related metacognitions. These, in turn, prospectively predicted suicide-specific rumination but not thought suppression. Mediation analyses indicated that positive metacognitions mediated the relationship between past suicidal ideation and future suicide-specific rumination. Additionally, suicide-specific rumination-rather than thought suppression-mediated the relationship between suicide-related metacognitions and both intensity and frequency of suicidal intent during the EMA period.

Limitations: Attentional fixation was not assessed. EMA compliance averaged 48.3%, and some measures were adapted from preliminary versions.

Conclusions: Findings provide the first longitudinal support for the metacognitive model of suicidality in a clinical sample. Suicide-specific rumination and positive metacognitions may be important drivers of intensification and prolongation of suicidal ideation and suicidal intent formation in the high-risk post-discharge period.

Test anxiety is a common emotional problem that often negatively affects academic performance. To examine the potential of transcranial direct current stimulation (tDCS) in modulating neural inhibitory control efficiency in individuals with high test anxiety, this study investigated the intervention effects and underlying neural mechanisms. A total of 42 participants with high or low levels of test anxiety were recruited. Each participant received both active (anodal) and sham tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), while event-related potentials (ERPs) were recorded during a Flanker task that indexes inhibitory control by requiring participants to respond to a central target while ignoring distracting flankers. Results showed that, compared to sham stimulation, active tDCS significantly reduced the amplitude of the P3 component-a late positive potential associated with attentional allocation-in the high test anxiety group, but had no significant effect in the low test anxiety group. These findings suggest that tDCS modulates neural inhibitory control in individuals with high test anxiety by activating the left DLPFC. This study provides electrophysiological evidence for non-invasive neuromodulation as a potential intervention strategy and identifying a promising neural target.

Background: Suicide represents an underappreciated contributor to drug-related mortality, with 20%-30% of opioid overdoses estimated to be intentional. However, suicide risk relative to opioid use disorder (OUD) severity has not been well characterized. Understanding suicidality risk across the OUD severity spectrum will inform which healthcare providers should be screening and treating self-harm.

Methods: We estimated the odds of past-year suicidal thoughts, plans, and attempts relative to OUD severity using data from the National Survey on Drug Use and Health (NSDUH), a cross-sectional, nationally representative, population-based survey study of noninstitutionalized individuals. Data were analyzed for adults (18+) from 2021 to 2023 (N = 139,524). Past-year DSM-5 OUD, OUD severity, and past-year suicidal thoughts, plans, and attempts were estimated, and logistic regression was utilized to assess the association of OUD severity with suicidality measures.

Results: Among individuals with OUD, 62.9% (95% CI, 60.1%-65.6%) had mild, 15.9% (95% CI, 13.5%-18.6%) had moderate, and 21.2% (95% CI, 19.1%-23.6%) had severe OUD. Individuals with OUD were at increased odds of reporting suicidal thoughts compared to individuals without OUD: mild OUD was associated with 2.18-fold greater odds (95% CI, 1.61-2.95), moderate OUD was associated with 1.88-fold greater odds (95% CI, 1.08-3.28), and severe OUD was associated with 4.17-fold greater odds (95% CI, 2.99-5.82). Individuals with OUD were also at increased odds of reporting a suicide plan relative to no OUD: mild OUD was associated with 3.35-fold greater odds (95% CI, 2.07-5.41), moderate OUD was associated with 4.66-fold greater odds (95% CI, 2.66-8.17), and severe OUD was associated with 6.70-fold greater odds (95% CI, 4.59-9.75). Lastly, across OUD severities, there was an increased odds of reporting a suicide attempt relative no OUD: mild OUD was associated with 2.80-fold greater odds (95% CI, 1.53-5.13), moderate OUD was associated with 8.45-fold greater odds (95% CI, 3.28-21.8), and severe OUD was associated with 9.96-fold greater odds (95% CI, 5.52-18.0).

Conclusions: These findings suggest OUD of any severity is associated with markedly increased risk of suicidal thoughts, plans, and suicide attempts. This highlights a continued need to integrate suicide screening and prevention into OUD treatment and clinical settings where opioids are frequently prescribed, such as primary care.