Personalized Medicine in Psychiatry最新文献

Schizophrenia is a complex disorder characterized by various symptoms, presentations, and prognostic outcomes. This diversity is attributed to its multifactorial origins, including genetic and environmental factors. Historically, antipsychotic medications have played a pivotal role in managing the disorder, but they exhibit varying degrees of response among patients. A significant percentage of patients do not respond favorably to conventional antipsychotic therapy. The push for personalized medicine highlights the need for treatment modalities tailored to individuals' genetic, biomarker, and psychosocial characteristics. Genome-wide association studies reveal schizophrenia as a polygenic disorder, indicating varied genetic profiles among patients. This genetic diversity suggests that different biological processes could impact each patient, leading to distinct clinical presentations. The emerging pharmacogenetics field could shift schizophrenia treatment from a trial-and-error basis to a more individualized approach. Concurrently, psychotherapy has become integral in schizophrenia management, addressing the disorder's heterogeneous nature. The move towards personalized therapy for schizophrenia offers a more dynamic, patient-focused approach, aiming for holistic recovery by intertwining evidence-based strategies with individual experiences. As the field evolves, integrating technological and neuroscientific developments promises improved therapeutic outcomes, promoting overall well-being.

Objective

Serotonin-Dopamine antagonists (SDA) have been evaluated as monotherapy and augmentation therapy for major depression (MDD) Despite evidence of efficacy for both, adverse events with SDA are considerably greater than for monotherapy. In this randomized clinical trial, low doses of pipamperone, an SDA approved in the EU, were used to treat major depression. We were in efficacy across treatments and the relative safety of pipamperone compared to previous treatments with SDA.

Methods

In this study, patients with MDD (n = 555; 535 received treatment) were randomized to low dose pipamperone plus placebo, citalopram plus placebo, or pipamperone plus citalopram in a 10-week efficacy study. Adverse events and clinician efficacy ratings with MADRS were examined.

Results

The study was completed by 383 participants, with the most common reason for drop out being withdrawal of consent. All three arms showed treatment-related changes with no significant differences between treatments (all effect sizes from larger than d = 1.48, largest = 1.77: pipamperone plus citalopram). Drop-outs due to adverse events were 4 % with pipamperone monotherapy, compared to 3 % with citalopram alone. There were no differences in weight gain across the treatments and EPS was reported by one case and tremor was reported by two cases with combined treatment arm. Nausea was more common with citalopram monotherapy (16 % vs 9 % for pipamperone).

Conclusions

These data suggest that low doses of pipamperone have a substantially better safety profile than previous SDA medications used to treat MDD and that pipamperone has potential to be an efficacious treatment for MD, as monotherapy or combination therapy.

Clinical Trials Registration

This trial was registered on clinicaltrials.gov: (NCT01312922).

Background

Brain-derived neurotrophic factor (BDNF) has been widely studied as a vulnerability factor for mental health disorders and is involved in learning and memory. We examined the association among the BDNF Val66Met genetic polymorphism (rs6265/G196A), risk for borderline personality disorder (BPD), and common co-morbidities of BPD (post-traumatic stress disorder (PTSD) and eating disorders (ED)). Furthermore, in this treatment study we were uniquely able to examine Val66Met in response to psychotherapy.

Methods

Data from 246 participants with BPD (82.1 % female, all white ancestry by self-report) were drawn from two randomized controlled trials. The association among BDNF Val66Met and comorbid ED and PTSD, as well as psychotherapy response was explored using chi-square analyses. The distribution of BDNF Val66Met in our BPD sample was also compared to the general population using the 1000 Genomes sample (n = 370).

Results

Carrying the Met allele was associated with a 1.9-fold [95 % CI:1.12–3.19] increased risk of having an ED (p = 0.017) and, specifically, a 2.5-fold [95 % CI:1.15–5.56] increased risk of having anorexia nervosa (p = 0.018). The Met allele was not associated with PTSD comorbidity or psychotherapy response. No significant difference was found between our BPD sample versus the general white population (p > 0.50).

Conclusion

In keeping with previous literature, carrying the Met allele was associated with increased risk of ED, particularly AN, among BPD individuals. Val66Met was not associated with BPD, comorbid PTSD, or psychotherapy response. Further studies, in larger and more diverse samples, incorporating other genes and modifications in the BDNF pathway, are warranted.

Conversion disorder (CD) is a psychological disorder characterized by neurological symptoms, without evidence of an organic etiology. CD is more common in women, and is recognized in children and adolescents. Functional MRI (fMRI) has been shown to be useful in providing functional correlation to patients’ symptoms, and that information opens a new window of understanding. We present a case in which the objective evidence provided by fMRI led to the successful rehabilitation of an adolescent patient: A 16-year-old presented with left hemiplegia and once a diagnosis of CD was made, was admitted to the rehabilitation department. An fMRI was performed – using a block design targeting motor and somatosensory stimulation tasks to the body parts with the greatest motor and sensory loss. The results enabled the patient to understand the physiologic correlates to her symptoms and improved rapidly. Validation of the patient’s condition provided the psychological spark allowing recovery to begin.

Modern medical advancements have revolutionized numerous fields; however, psychiatric research has yet to fully benefit from these techniques in delivering novel, personalized treatments to patients. Conversely, oncology has seen revolutions in cellular and immune therapies, moving into an era of basket trials and ever-increasing patient specificity. For psychiatry, ketamine and psychedelics (KPs) have shown promising initial results, yet clear gaps exist in basic mechanistic understanding and clinical application. Acknowledging important differences between the disciplines, this review highlights key strategies from translational oncology which may be informative and applicable to research with these medicines. By viewing KPs in the context of early-generation cellular, immune, and chemotherapies, researchers can leverage their inherent complexity and novelty to foster translational and regulatory progress. Following the cancer model, large scale collaborations to enhance biomarker and clinical outcomes data collection may be beneficial. KPs may also be uniquely suited to develop multi-modal treatment regimens, like those which have proven highly beneficial in cancer. This can provide synergy with targeted therapies, while helping to overcome and uncover patient heterogeneity.

Introduction

Teachers’ mental health could be affected as a result of significant changes imposed by the COVID-19 pandemic, including everyday responsibilities outside of their profession. In this context, we aimed to explore the prevalence of depressive symptoms (DS) among school teachers in Sfax, Southern Tunisia, and to investigate their main determinants.

Methods

It was a cross-sectional study involving public-school-teachers of all levels: primary, middle and high schools in Sfax Governorate, Southern Tunisia between March and April 2021 during the third wave of COVID-19 pandemic. The DS were evaluated using a French validated 20-item-version of the self-reported Depression Scale of the Centre for Epidemiologic Studies Depression Scale (CES-D). A cut-off point of 16 was recommended to define DS.

Results

Of the 525 teachers, 292 cases were females (55.6%), 256 teachers (48.8%) worked at high-schools and 478 cases were married (91%). The teachers’ median age was 48 years (Interquartile range (IQR) = [41–53] years). There were 245 teachers (46.7%) suffering from DS. In the multivariate analysis, female gender (Adjusted Odds Ratio (AOR) = 2.3; p < 0.001), history of chronic diseases (AOR = 2.5; p < 0.001) and having close contact with COVID-19 cases (AOR = 1.4; p = 0.04) were independently associated with depressive symptoms. Besides, university educational level (AOR = 0.56; p = 0.015), perceived workplace safety (AOR = 0.4; p < 0.001), consumption of coffee (AOR = 0.5; p = 0.006) and regular mask wearing in public spaces (AOR = 0.52; p = 0.048) were independently associated with lower prevalence of DS among teachers. In the multivariate analysis, female gender (Adjusted Odds Ratio (AOR) = 2.3; p < 0.001), history of chronic diseases (AOR = 2.5; p < 0.001) and having close contact with COVID-19 cases (AOR = 1.4; p = 0.04) were independently associated with depressive symptoms. Besides, university educational level (AOR = 0.56; p = 0.015), perceived workplace safety (AOR = 0.4; p < 0.001), consumption of coffee (AOR = 0.5; p = 0.006) and regular mask wearing in public spaces (AOR = 0.52; p = 0.048) were independently associated with lower prevalence of DS among teachers.

Conclusion

Personal, occupational and pandemic-related factors were found to be associated with higher risk of DS among teachers. Therefore, promoting awareness through offering psychological assistance and educational sessions about screening of mental health disorders among teachers is crucial for early detection and management.

COVID-19 pandemic has had a negative impact on the mental health and well-being of people across the world. It was hypothesized that the pandemic would exacerbate the severity of ED symptomatology due to greater levels of anxiety, emotional dysregulation and stress related to social isolation and loneliness.

In this observational study, 508 undergraduate Italian students voluntary participated in an online survey to investigate the psycho-behavioural impact of COVID-19 pandemic on the risk of BED related to psychological disease such as dysfunctional anxiety and fear associated with COVID-19 and post-traumatic stress disorder linked to COVID-19, as well as personality traits and overall well-being in prolonged pandemic.

Findings evidenced that individuals affected by binge eating symptoms tended to develop low ‘Sense of Meaning’ as well ‘Overall Well-Being’. People at risk for BED are not oriented toward giving direction and meaning to their life and these aspects could significantly affect the ability to be well oriented to pursue goals in a planned manner and general well-being.

This study points out the negative psychological impact of the pandemic outbreak and the high vulnerability of individuals at risk for BED.

Objective

The potential psychological impact of COVID-19 have been evaluated in enormous prevalence studies in medical students, however, pooled and precise prevalence is needed to judgment about the true burden. The aim of this systematic review and meta-analysis is to summarize and synthesize published studies on the prevalence of stress, anxiety and depression among medical students during the COVID-19 pandemic.

Methods

A systematic search utilizing PubMed, Scopus and Web of Sciences was conducted for retrieving original studies that examined the prevalence of stress, anxiety and depression among medical students through September 18, 2021. Random effects model using inverse variance method was applied to estimate pool prevalence. Subgroup analyses were performed to evaluate the variation of the study outcomes according to the used questionnaire and the world health organization (WHO) regions.

Results

One hundred eight studies were included in a systematic review and of them, 52 were considered for various meta-analysis. Pooling of included studies showed prevalence estimates (95 % CI) of 0.50 (0.39 0.62), 0.44 (0.38, 0.50) and 0.49 (0.41, 0.56) for stress, anxiety and depression, respectively. The prevalence of the mental states was higher among medical students in Eastern Mediterranean Region (EMR) compared to other WHO regions.

Conclusion

Our findings showed large figures for the prevalence of stress, anxiety and depression among medical students during the COVID-19 pandemic. Medical schools should monitor the status of medical students under pandemic circumstances in term of stress, depression and anxiety.

Research into misophonia treatments has been limited and it is unclear what treatment approaches may be effective. This systematic review extracted and synthesized relevant treatment research on misophonia to examine the efficacy of various intervention modalities and identify current trends in order to guide future treatment research. PubMed, PsycINFO, Google Scholar, and Cochrane Central were searched using the keywords “misophonia,” “decreased sound tolerance,” “selective sound sensitivity,” or “decreased sound sensitivity.” Of the 169 records available for initial screening, 33 studied misophonia treatment specifically. Data were available for one randomized controlled trial, one open label trial, and 31 case studies. Treatments included various forms of psychotherapy, medication, and combinations of the two. Cognitive-behavioral therapy (CBT) incorporating various components has been the most often utilized and effective treatment for reduction of misophonia symptoms in one randomized trial and several case studies/series. Beyond CBT, various case studies suggested possible benefit from other treatment approaches depending on the patient’s symptom profile, although methodological rigor was limited. Given the limitations in the literature to date, including overall lack of rigor, lack of comparative studies, limited replication, and small sample size, the field would benefit from the development of mechanism-informed treatments, rigorous randomized trials, and treatment development with an eye towards dissemination and implementation.