Personalized Medicine in Psychiatry最新文献

英文中文

Multiple marginalized identities: Multilevel analysis of COVID-19 impacts on youth mental and behavioral health 多重边缘身份：新冠肺炎对青少年心理和行为健康影响的多层次分析

Personalized Medicine in Psychiatry

Pub Date : 2026-01-25 DOI: 10.1016/j.pmip.2026.100178

Jennifer D. Runkle , Kelsey Herbst , Sohpia C. Ryan , Martie P. Thompson , Margaret M. Sugg

Objective

The COVID-19 pandemic exacerbated youth mental and behavioral health challenges in the United States, disproportionately impacting minoritized groups. Few studies examine how intersecting social determinants jointly shape these outcomes, particularly in underserved regions. This study applied an intersectional framework to assess pandemic-related changes and identify highest-risk strata.

Methods

We applied a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy model to emergency department data (2010–2022) to estimate pre- and post-pandemic prevalence of depression, anxiety, self-harm, and attention-deficit/hyperactivity disorder among youth (ages 5–26) in western North Carolina (WNC) (n = 934,938) and statewide (n = 11,973,484). Intersectional strata were defined by COVID-19 period, sex, race/ethnicity, insurance type, and age. Predicted prevalence identified highest-risk strata for each outcome and region.

Results

Lowest-risk strata were consistently pre-COVID, elementary-aged children with self-pay insurance, often male and from minoritized racial/ethnic groups. Highest-risk strata for depression and anxiety were post-COVID, young adult females with insurance across multiple racial/ethnic groups, with prevalence up to 11.9% (depression) and 12.9% (anxiety) in WNC. For self-harm, post-COVID adolescent females with insurance had the highest risk, with slightly higher prevalence in WNC (1.5%) than NC (1.4%). ADHD showed distinct patterns, with highest prevalence among male adolescents with Medicaid (7.1% in WNC, 11.4% statewide).

Conclusions

Intersectional analysis revealed both shared and region-specific disparities. WNC showed higher top-risk prevalence for depression, anxiety, and self-harm, while statewide strata showed higher ADHD risk. Findings support regionally tailored prevention strategies, including rural workforce expansion, culturally responsive care, and standardized diagnostic practices.

新冠肺炎大流行加剧了美国青少年的心理和行为健康挑战，对少数群体的影响尤为严重。很少有研究调查交叉的社会决定因素如何共同塑造这些结果，特别是在服务不足的地区。这项研究采用了交叉框架来评估与大流行相关的变化并确定最高风险阶层。方法我们应用个体异质性的多水平分析和区分准确性模型对急症科数据（2010-2022）进行分析，以估计大流行前和大流行后北卡罗来纳州西部（n = 934,938）和全州（n = 11,973,484）青少年（5-26岁）抑郁、焦虑、自残和注意缺陷/多动障碍的患病率。交叉阶层由COVID-19时期、性别、种族/民族、保险类型和年龄定义。预测流行率确定了每个结果和区域的最高风险阶层。结果最低风险阶层始终是患有自费保险的初等年龄儿童，通常是男性和少数民族。抑郁和焦虑的最高风险阶层是多个种族/族裔群体中患有保险的年轻成年女性，在WNC中患病率高达11.9%（抑郁）和12.9%（焦虑）。在自残方面，有保险的新冠后青少年女性的自残风险最高，WNC（1.5%）略高于NC（1.4%）。ADHD表现出不同的模式，在接受医疗补助的男性青少年中患病率最高（WNC为7.1%，全州为11.4%）。结论：通过截面分析，发现了共性差异和地区差异。WNC显示出更高的抑郁、焦虑和自残的最高风险患病率，而全州范围内的人群显示出更高的ADHD风险。研究结果支持有针对性的区域预防战略，包括扩大农村劳动力、符合文化的护理和标准化诊断做法。

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引用次数: 0

Lithium toxicity with GLP-1RA co-prescription: clinical considerations and recommendations 锂毒性GLP-1RA联合处方：临床考虑和建议

Personalized Medicine in Psychiatry

Pub Date : 2025-12-29 DOI: 10.1016/j.pmip.2025.100177

Sonia Seth , Seethalakshmi Ramanathan

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Lithium carbonate are widely prescribed drugs for type 2 diabetes mellitus and bipolar disorder, respectively. The pharmacokinetic interaction between these commonly prescribed drugs has not yet been documented in the literature, despite their extended clinical usage. Here, we present a clinical case in which Lithium carbonate and Tirzepatide administration was temporally associated with Lithium toxicity. We discuss potential mechanisms including volume-depleting gastrointestinal effects leading to dehydration affecting lithium renal clearance, and elevating serum lithium levels. Finally, we propose clinical recommendations and guidelines including frequent monitoring of Li levels and renal function markers in patients who are prescribed GLP-1 RAs and lithium concurrently.

胰高血糖素样肽-1受体激动剂（GLP-1 RAs）和碳酸锂分别被广泛用于治疗2型糖尿病和双相情感障碍。这些常用处方药之间的药代动力学相互作用尚未在文献中记录，尽管它们的广泛临床使用。在这里，我们提出了一个临床病例，其中碳酸锂和替西帕肽给药与锂毒性暂时相关。我们讨论了潜在的机制，包括导致脱水的胃肠衰竭效应，影响锂的肾脏清除，并提高血清锂水平。最后，我们提出了临床建议和指南，包括在同时服用GLP-1 RAs和锂的患者中频繁监测Li水平和肾功能指标。

引用次数: 0

Historical roots of depressive symptoms in older adults: Gam Saan songs 老年人抑郁症状的历史根源：Gam Saan歌曲

Personalized Medicine in Psychiatry

Pub Date : 2025-12-22 DOI: 10.1016/j.pmip.2025.100176

Benjamin K.P. Woo , Jamie O.P. Chung

引用次数: 0

Diet and depression risk: Addressing methodological reflections 饮食和抑郁风险：处理方法反思

Personalized Medicine in Psychiatry

Pub Date : 2025-12-16 DOI: 10.1016/j.pmip.2025.100175

Patricio Molero , Francesco De Lorenzi , Adam Gędek , Celina Strater , Elena Popescu , Felipe Ortuño , Willem Van Der Does , Miguel Angel Martínez-González , Marc L. Molendijk

引用次数: 0

Young Adults’ experiences of dental Anxiety: A multidisciplinary qualitative study of Triggers, Avoidance, and intervention strategies 年轻人牙科焦虑的经历：触发、避免和干预策略的多学科定性研究

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100169

Azizi Ab Malek , Nawwal Alwani Mohd Radzi , Muhd Firdaus Che Musa

Dental anxiety is a clinically significant condition that shares core features with specific phobia, including anticipatory fear, autonomic arousal, and behavioral avoidance. Particularly prevalent among young adults, dental anxiety contributes to delayed treatment, deteriorating oral health, and psychological distress. Despite various intervention efforts, limited research has examined the emotional, cognitive, and contextual factors underlying dental anxiety through a multidisciplinary lens. This qualitative study explored the lived experiences and clinical insights of young adults, dentists, and mental health professionals in managing dental anxiety. Using Braun and Clarke’s reflexive thematic analysis, data from focus group discussions with 18 dentists and in-depth interviews with 16 high-anxiety young adults (MDAS ≥ 19) and 4 mental health professionals (clinical psychologists and psychiatrists) were inductively analyzed with NVivo software. Ten interrelated themes emerged across five core domains: (1) psychological mechanisms including autonomic symptoms and anxiety-driven behaviors; (2) trauma-related conditioning rooted in early dental experiences; (3) cognitive-affective patterns shaped by trust, fear of the unknown, and perceived control; (4) intervention preferences emphasizing visual tools and empathic delivery; and (5) behavioral and systemic outcomes such as treatment avoidance and increased resource demands. Findings support trauma-informed, multidisciplinary care models incorporating early screening, sensory-adapted environments, and structured psychoeducation. Dental anxiety should be reframed within broader mental health frameworks to enhance psychological safety, improve engagement and reduce long-term burden.

牙科焦虑是一种临床意义重大的疾病，其核心特征与特定恐惧症相同，包括预期恐惧、自主神经觉醒和行为回避。牙齿焦虑在年轻人中尤为普遍，它会导致治疗延误、口腔健康恶化和心理困扰。尽管有各种各样的干预措施，但有限的研究已经通过多学科的视角检查了牙齿焦虑的情感、认知和背景因素。本定性研究探讨了年轻人、牙医和心理健康专业人员在处理牙齿焦虑方面的生活经验和临床见解。采用Braun和Clarke的反思性主题分析，采用NVivo软件对18名牙医的焦点小组讨论、16名高焦虑青年（MDAS≥19）和4名心理健康专业人员（临床心理学家和精神科医生）的深度访谈数据进行归纳分析。在五个核心领域中出现了十个相互关联的主题：(1)包括自主症状和焦虑驱动行为在内的心理机制；(2)创伤相关条件反射，根植于早期牙科经历；(3)信任、未知恐惧和感知控制形成的认知情感模式；(4)注重视觉工具和共情传递的干预偏好；(5)行为和系统结果，如治疗回避和资源需求增加。研究结果支持创伤知情、多学科护理模式，包括早期筛查、感觉适应环境和结构化心理教育。牙科焦虑应在更广泛的心理健康框架内重新定义，以加强心理安全，改善参与和减少长期负担。

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引用次数: 0

A global longitudinal study of social-ecological factors affecting depression and anxiety during COVID-19 COVID-19期间影响抑郁和焦虑的社会生态因素的全球纵向研究

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100168

Abbeygail Jones , Vaughan Bell , Keri Ka-Yee Wong

Background

This study models depression and anxiety over time and the effect of individual, relational, community and societal-level predictors during the initial COVID-19 outbreak, to explore important factors for research or clinical practice.

Methods

Pre-registered analysis was conducted on longitudinal survey data from The Global Social Trust and Mental Health Study conducted between April 2020 and July 2021. There were 2345 respondents with data available for analysis across 6 continents (70.6 % female, 24.7 % male, mean age 36.4 years). Anxiety and depression symptoms were stable and low (below clinical cut-offs) on average. Random Intercept Cross-lagged Panel Models and Latent Transition Analysis estimated the effects of parental status, household chaos, household crowding, outdoor access, demographic variables, and lockdown stringency on depression and anxiety symptoms.

Conclusions

In line with the Social Ecological Model, multi-level factors were associated with anxiety and depression. Female gender, younger age, non-marginalised ethnicity, lower socioeconomic status, not being a parent, higher household chaos, less outdoor access and lower lockdown stringency were associated with the greater levels of depression and anxiety across the study.

本研究对COVID-19爆发初期抑郁和焦虑随时间的变化以及个体、关系、社区和社会层面预测因素的影响进行建模，以探索研究或临床实践的重要因素。方法对2020年4月至2021年7月进行的全球社会信任与心理健康研究的纵向调查数据进行预注册分析。共有来自六大洲的2345名受访者提供可用于分析的数据（70.6%为女性，24.7%为男性，平均年龄36.4岁）。焦虑和抑郁症状稳定且平均较低（低于临床临界值）。随机截距交叉滞后面板模型和潜在过渡分析估计了父母身份、家庭混乱、家庭拥挤、室外通道、人口统计变量和封锁严格程度对抑郁和焦虑症状的影响。结论与社会生态模型一致，焦虑、抑郁与多因素相关。在整个研究中，女性、年轻、非边缘化种族、较低的社会经济地位、不为人父母、较高的家庭混乱、较少的户外活动和较低的封锁严格程度与较高的抑郁和焦虑水平有关。

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引用次数: 0

Corrigendum to “A global longitudinal study of social-ecological factors affecting depression and anxiety during COVID-19” [Personal. Med. Psychiatr. 53–54C (2025) 100168] “COVID-19期间影响抑郁和焦虑的社会生态因素的全球纵向研究”的勘误表[个人]。精神医学。53-54C (2025) 100168]

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100173

Abbeygail Jones , Vaughan Bell , Keri Ka-Yee Wong

引用次数: 0

Prediction of sustained benefits from computerized training in older individuals with and without mild cognitive impairment: A machine-learning comparison of participant characteristics, baseline performance, and training gains 预测有或无轻度认知障碍的老年人计算机化训练的持续益处：参与者特征、基线表现和训练收益的机器学习比较

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100172

Justin Macchiarelli , Varsha D. Badal , Andrea Rivera-Molina , Peter Kallestrup , Sara J. Czaja , Philip D. Harvey

Background

Computerized training has demonstrated efficacy in people with mild cognitive impairment (MCI), but benefits vary across participants. Identifying risk for poor outcomes could inform personalization. We previously identified participants who mastered this 6-task digital training program with a baseline algorithm. Here we report on prediction of durability of training gains using machine learning.

Methods

MCI (n = 84) and NC (n = 68) participants received remote, computerized functional skills training (FUNSAT™), twice a week for up to 12 weeks. Half of the MCI participants had a burst of cognitive training before skills training. Training gains for both groups had effect sizes >0.75. 30 days post-training, participants were reassessed for durability of gains (≥80 %). Machine Learning analyses, predicted durability using individual characteristics (e.g., cognitive performance), baseline task performance, or training features (e.g., amount of training, training gains per session). We examined easiest (Ticket Purchase) and hardest (Internet Banking) tasks.

Results

Durability was 78 % for ticket and 65 % for banking. Most informative predictors of durability were training process variables: improvement in completion time for ticket and completion time end of training for banking. For ticket, three baseline measures were also informative.

Discussion

FUNSAT training results were durable for most participants and process variables were the best predictors. Variables that previously identified failure in mastery did not predict durability of gains. Computerized cognitive training added to FUNSAT training did add to durability for MCI participants These results suggest that identifying predictors of different types of poor training outcomes could personalize computerized training to increase mastery and durability.

计算机化训练已被证明对轻度认知障碍（MCI）患者有效，但益处因参与者而异。识别不良结果的风险可以为个性化提供信息。我们之前用基线算法确定了掌握了6个任务的数字培训计划的参与者。在这里，我们报告了使用机器学习预测训练增益的持久性。方法smci （n = 84）和NC （n = 68）参与者接受远程、计算机化的功能技能培训（FUNSAT™），每周两次，持续12周。一半的MCI参与者在技能训练之前进行了认知训练。两组的训练收益效应值为>；0.75。训练后30天，参与者重新评估获益的持久性（≥80%）。机器学习使用个体特征（如认知表现）、基线任务表现或训练特征（如训练量、每次训练收益）进行分析和预测耐久性。我们研究了最简单（购票）和最难（网上银行）的任务。结果购票和银行服务的持久性分别为78%和65%。最具信息预测性的持久性是培训过程变量：票据完成时间的改善和银行培训结束时间的改善。对于机票，三个基线测量也提供了信息。讨论funsat训练结果对大多数参与者来说是持久的，过程变量是最好的预测因子。以前识别精通失败的变量并不能预测获得的持久性。计算机化的认知训练加入到FUNSAT训练中确实增加了MCI参与者的持久性。这些结果表明，识别不同类型的不良训练结果的预测因子可以个性化计算机化训练，以提高掌握和持久性。

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引用次数: 0

Cut-off points for impaired insight in bipolar disorder using the insight scale for affective disorders 使用情感障碍洞察力量表的双相情感障碍洞察力受损的分界点

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100174

Anna Luiza Guimarães , Eduardo Fernandes , Isadora Salgado , Rafael de Assis da Silva , Antonio Egídio Nardi , Elie Cheniaux , Daniel C. Mograbi

Impaired insight is a key feature of bipolar disorder (BD), particularly during manic episodes, and is associated with poorer clinical outcomes. Although the Insight Scale for Affective Disorders (ISAD) is widely used to assess insight in mood disorders, standardized cut-off scores to distinguish levels of insight impairment have not been established. Here, we conducted Receiver Operating Characteristic (ROC) curve analysis to identify ISAD thresholds that best discriminated between preserved, moderately, and severely impaired insight in 126 individuals with BD, using a clinical interview as a gold standard. The optimal ISAD cut-off for moderate insight impairment was ≥21, yielding a sensitivity of 94.1 % and a specificity of 71.7 % (AUC = 0.91). For severe impairment, the optimal cut-off was ≥27, with a sensitivity of 95.2 % and a specificity of 90.5 % (AUC = 0.97). Insight impairment was most prevalent in manic states and least common in euthymia/depression/mixed states, consistent with prior literature. The ISAD demonstrated excellent to outstanding accuracy in detecting varying levels of insight impairment in BD. The identified cut-off points can assist clinical decision-making, facilitate stratification, and support future research on psychosocial interventions designed to mitigate reduced insight and its consequences.

洞察力受损是双相情感障碍（BD）的一个关键特征，特别是在躁狂发作期间，并且与较差的临床结果相关。虽然情感障碍洞察力量表（ISAD）被广泛用于评估情绪障碍的洞察力，但尚未建立标准化的截止分数来区分洞察力损害的水平。在这里，我们使用临床访谈作为金标准，对126名双相障碍患者进行受试者工作特征（ROC）曲线分析，以确定ISAD阈值，该阈值可以最好地区分保留的、中度的和严重的洞察力受损。中度视力障碍的最佳ISAD临界值≥21，敏感性为94.1%，特异性为71.7% （AUC = 0.91）。对于严重损伤，最佳临界值≥27，敏感性为95.2%，特异性为90.5% （AUC = 0.97）。洞察力障碍在躁狂状态中最普遍，在心境/抑郁/混合状态中最不常见，与先前的文献一致。ISAD在检测双相障碍中不同程度的洞察力障碍方面表现出卓越的准确性。确定的分界点可以帮助临床决策，促进分层，并支持未来旨在减轻洞察力下降及其后果的社会心理干预研究。

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引用次数: 0

Cognitive behavioural therapy for perinatal insomnia: A systematic review on postpartum outcomes 围产期失眠症的认知行为疗法：产后结果的系统回顾

Personalized Medicine in Psychiatry

Pub Date : 2025-11-01 DOI: 10.1016/j.pmip.2025.100167

Laura Szabo , Lizzy Taylor

Insomnia is highly prevalent in the perinatal period and is associated with postpartum depression (PPD) and adverse maternal and infant outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is an established treatment in the general population, with proven short- and long-term effects. Although research on perinatal insomnia is still emerging, several recent randomised controlled trials (RCTs) have tested its postpartum efficacy. This systematic review examined the evidence of CBT-I in treating postpartum insomnia and reducing PPD.

Six databases were searched from their earliest available records to July 2024, yielding a total of 408 records. Eight trials met the inclusion criteria, which were methodologically appraised using the Cochrane Risk of Bias tool (RoB-2). Due to substantial clinical and methodological heterogeneity, a narrative synthesis was conducted.

Across studies, CBT-I produced small to medium effects on insomnia outcomes during early and mid-postpartum, with larger effects emerging in late postpartum. Effects on depressive symptoms were inconsistent and generally small. Overall certainty of evidence was low due to high risk of bias, small sample sizes, heterogeneous control conditions, and limited reporting of key postpartum confounders (e.g., infant night waking, breastfeeding, pharmacological sleep aid use). CBT-I shows potential for improving postpartum insomnia, but current evidence is insufficient to support strong clinical recommendations. Larger, methodologically rigorous trials with postpartum-specific adaptations and diverse samples are needed.

失眠在围产期非常普遍，并与产后抑郁症（PPD）和不良母婴结局有关。认知行为疗法治疗失眠症（CBT-I）在普通人群中是一种成熟的治疗方法，具有已证实的短期和长期效果。尽管围产期失眠的研究仍在兴起，但最近的几项随机对照试验（RCTs）已经测试了其产后疗效。本系统综述研究了CBT-I治疗产后失眠和减少产后抑郁的证据。从最早的可用记录到2024年7月，对6个数据库进行了检索，共获得408条记录。8项试验符合纳入标准，使用Cochrane偏倚风险工具（rob2）对其进行方法学评价。由于临床和方法的异质性，我们进行了叙事综合。在所有研究中，CBT-I在产后早期和中期对失眠结果产生了小到中等的影响，在产后后期出现了较大的影响。对抑郁症状的影响不一致，通常很小。由于偏倚风险高、样本量小、异质对照条件以及产后关键混杂因素（如婴儿夜醒、母乳喂养、药物助眠）的报道有限，证据的总体确定性较低。CBT-I显示出改善产后失眠的潜力，但目前的证据不足以支持强有力的临床推荐。需要更大的、方法学上严格的、针对产后适应性和不同样本的试验。

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