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The Extrapyramidal Symptom Rating Scale and Its Abbreviated Version: A Critical Review of Clinimetric Properties 锥体外系症状评定量表及其缩略版:临床测量特性评述
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-12-07 DOI: 10.1159/000535113
Guy Chouinard, F. Cosci, V. Chouinard, Larry Alphs
Background: The Extrapyramidal Symptom Rating Scale – Abbreviated (ESRS-A) is an abbreviated version of the Extrapyramidal Symptom Rating Scale (ESRS) with instructions, definitions, and a semi-structured interview that follows clinimetric concepts of measuring clinical symptoms. Similar to the ESRS, the ESRS-A was developed to assess four types of drug-induced movement disorders (DIMD): parkinsonism, akathisia, dystonia, and tardive dyskinesia (TD). Summary: The present review of the literature provides the most relevant clinimetric properties displayed by the ESRS and ESRS-A in clinical studies. Comprehensive ESRS-A definitions, official scale, and basic instructions are provided. ESRS inter-rater reliability was evaluated in two pivotal studies and in multicenter international studies. Inter-rater reliability was high for assessing both antipsychotic-induced movement disorders and idiopathic Parkinson’s disease. Guidelines were also established for inter-rater reliability and the rater certification processes. The ESRS showed good concurrent validity with 96% agreement between Abnormal Involuntary Movement Scale (AIMS) for TD-defined cases and ESRS-defined cases. Similarly, concurrent validity for ESRS-A total and subscores for parkinsonism, akathisia, dystonia, and dyskinesia ranged from good to very good. The ESRS was particularly sensitive for detecting DIMD-related movement differences following treatment with placebo, antipsychotics, and antiparkinsonian and antidyskinetic medications. ESRS measurement of drug-induced extrapyramidal symptoms was shown to discriminate extrapyramidal symptoms from psychiatric symptoms. Key Messages: The ESRS and ESRS-A are valid clinimetric indices for measuring DIMD. They can be valuably implemented in clinical research, particularly in trials testing antipsychotic medications, and in clinics to detect the presence, severity, and response to treatment of movement disorders.
背景:锥体外系症状评定量表-简略版(ESRS- a)是锥体外系症状评定量表(ESRS)的简略版,具有说明、定义和半结构化访谈,遵循测量临床症状的临床计量概念。与ESRS类似,ESRS- a被开发用于评估四种类型的药物性运动障碍(DIMD):帕金森病、静坐症、肌张力障碍和迟发性运动障碍(TD)。摘要:目前的文献综述提供了ESRS和ESRS- a在临床研究中显示的最相关的临床计量学特性。提供了全面的ESRS-A定义,官方规模和基本说明。在两项关键性研究和多中心国际研究中评估了ESRS量表间的可靠性。评估抗精神病药物引起的运动障碍和特发性帕金森病的评分间信度很高。还为评级机构之间的可靠性和评级机构核证程序制定了准则。ESRS显示了良好的并发效度,td定义病例的异常不自主运动量表(AIMS)与ESRS定义病例的一致性为96%。同样,ESRS-A的帕金森病、无运动障碍、肌张力障碍和运动障碍的总分和分值的并发效度范围从好到非常好。在接受安慰剂、抗精神病药物、抗帕金森和抗运动障碍药物治疗后,ESRS对检测与dimd相关的运动差异特别敏感。ESRS测量药物引起的锥体外系症状被证明可以区分锥体外系症状和精神症状。关键信息:ESRS和ESRS- a是测量DIMD的有效临床指标。它们可以在临床研究中有价值地实施,特别是在抗精神病药物的试验中,以及在诊所中检测运动障碍的存在、严重程度和治疗反应。
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引用次数: 0
Front & Back Matter 正面和背面事项
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-06-01 DOI: 10.1159/000531618
J. Guidi, G. Fava, J. Leon
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引用次数: 0
Front & Back Matter 正面和背面
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-05-01 DOI: 10.1159/000531123
J. Guidi, J. Leon
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引用次数: 0
At the head and heart of oxytocin: An RCT investigating stress-regulatory neural and cardiac effects of chronic administration in children with autism 在催产素的头部和心脏:一项研究自闭症儿童长期服用催产素对应激调节神经和心脏影响的随机对照试验
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-04-04 DOI: 10.1101/2023.04.04.23288109
K. Alaerts, N. Daniels, M. Moerkerke, Margaux Evenepoel, Tiffany Tang, S. Van der Donck, V. Chubar, Stephan Claes, Jean Steyaert, Bart Boets, J. Prinsen
Intranasal administration of oxytocin is increasingly explored as a new approach to facilitate social development and reduce disability associated with a diagnosis of autism spectrum disorder (ASD). In light of the growing number of trials, it is crucial to gain deeper insights into the neuroplastic changes that are induced from multiple-dose, chronic use of oxytocin, over a course of weeks. To date however, the neuromodulatory impact of oxytocin in the pediatric brains remains unknown. Here, we present a double-blind, randomized, placebo-controlled pharmaco-neuroimaging trial examining the neural effects of a four-week intranasal oxytocin administration regime (12 IU, twice daily) in pre-pubertal school-aged children with ASD (8-12 years, 45 boys, 12 girls). Resting-state fMRI scanning and simultaneous, in-scanner heart rate measurements were assessed before, immediately after and four weeks after the nasal spray administration period. Four weeks of chronic oxytocin administration in children with ASD induced significant reductions in intrinsic functional connectivity between amygdala and orbitofrontal cortex, particularly at the four-week follow-up session, thereby replicating prior observations of neuromodulatory changes in the adult brain. Notably, the observed reductions in amygdala-orbitofrontal connectivity were associated with improved autonomic stress-regulation, indexed by increased high-frequency heart rate variability. Further, oxytocin-related neural and cardiac autonomic effects were significantly modulated by epigenetic modifications of the oxytocin receptor gene, indicating that oxytocin-induced stress-regulatory effects were more pronounced in children with reduced epigenetic methylation, and thus higher oxytocin receptor expression. Finally, whole-brain exploratory functional connectivity analyses also revealed an overall oxytocin-induced enhancing effect on amygdala coupling to regions of the salience network (insula, anterior cingulate cortex), likely reflective of oxytocin-induced (social) salience effects. Together, these observations provide initial insights into the stress-regulatory neural and cardiac effects induced by chronic oxytocin administration in children with ASD, and point toward important epigenetic modulators that may explain inter-individual variations in oxytocin-induced responses.
鼻内给药催产素作为一种促进社会发展和减少与自闭症谱系障碍(ASD)诊断相关的残疾的新方法,正被越来越多地探索。鉴于越来越多的试验,深入了解在数周时间内多次、长期使用催产素所引起的神经可塑性变化是至关重要的。然而,到目前为止,催产素对儿童大脑的神经调节作用仍然未知。在这里,我们提出了一项双盲、随机、安慰剂对照的药物-神经影像学试验,研究了在青春期前学龄ASD儿童(8-12岁,45名男孩,12名女孩)中,为期四周的鼻内催产素给药方案(12 IU,每天两次)的神经效应。静息状态fMRI扫描和同时进行的扫描仪内心率测量分别在鼻腔喷雾剂给药前、后和给药后四周进行评估。在ASD儿童中,4周的慢性催产素治疗导致杏仁核和眶额叶皮层之间的内在功能连接显著减少,特别是在4周的随访中,从而复制了先前在成人大脑中观察到的神经调节变化。值得注意的是,观察到的杏仁核-眼窝额叶连通性的减少与自主应激调节的改善有关,这与高频心率变异性的增加有关。此外,催产素相关的神经和心脏自主神经作用被催产素受体基因的表观遗传修饰显著调节,这表明催产素诱导的应激调节作用在表观遗传甲基化降低的儿童中更为明显,因此催产素受体表达更高。最后,全脑探索性功能连通性分析也揭示了催产素诱导的杏仁核与突出网络区域(脑岛、前扣带皮层)耦合的整体增强效应,这可能反映了催产素诱导的(社会)突出效应。总之,这些观察结果为ASD儿童慢性催产素治疗诱导的应激调节神经和心脏效应提供了初步见解,并指出了重要的表观遗传调节剂,可以解释催产素诱导的反应的个体间差异。
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引用次数: 0
Guidelines Circulated for the Prescription of Benzodiazepines Are Out of Synch with Clinical Practice and Evidence-Based Reviews. 苯二氮卓类药物处方指南与临床实践和循证评价不同步。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 DOI: 10.1159/000527817
David Fogelson
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引用次数: 2
The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial. 青少年正念疗法(MYmind)与群体认知行为疗法在改善注意缺陷多动障碍儿童及其父母的注意力和减少行为问题中的作用:一项随机对照试验。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 Epub Date: 2023-12-01 DOI: 10.1159/000534962
Samuel Yeung Shan Wong, Stanley Kam Chung Chan, Benjamin Hon Kei Yip, Wenyue Wang, Herman Hay Ming Lo, Dexing Zhang, Susan M Bögels

Introduction: There is a lack of studies evaluating mindfulness-based interventions for children with attention-deficit hyperactivity disorder (ADHD) compared with an evidence-based control. This randomized controlled trial (RCT) evaluated the effects of mindfulness for youth (MYmind) in improving children's attention, behavior, and parent-related outcomes versus cognitive behavioral therapy (CBT).

Methods: A total of 138 families of children with ADHD aged 8-12 years were recruited from the community with 69 randomized to MYmind and 69 to CBT. Participants were assessed at baseline, immediately after intervention, at 3 months and 6 months. The primary outcome was the attention score of the Sky Search subtest of the Test of Everyday Attention for Children (TEA-Ch). Secondary outcomes were child behavior and parent-related assessments. Linear mixed models were used to assess the efficacy of MYmind compared with CBT.

Results: Both MYmind and CBT significantly improved children's attention score at 6 months (MYmind: β = 1.48, p = 0.013, Cohen's d = 0.32; CBT: β = 1.46, p = 0.008, d = 0.27). There were significant within-group improvements in most secondary outcomes. No significant difference was shown for both primary or secondary outcomes between the two arms at any time point.

Conclusions: Both MYmind and CBT appeared to improve children's attention and behavior outcomes, although no difference was found between these two interventions. This is the largest RCT so far comparing MYmind and CBT although there was loss of follow-up assessments during the pandemic. Further RCTs adopting a non-inferiority design are needed to validate the results.

前言:目前还缺乏评估正念干预对儿童注意缺陷多动障碍(ADHD)与循证对照的研究。这项随机对照试验(RCT)评估了青少年正念(MYmind)与认知行为疗法(CBT)相比,在改善儿童注意力、行为和父母相关结果方面的效果。方法:从社区中招募138个8-12岁ADHD儿童家庭,其中69个随机分为MYmind组,69个随机分为CBT组。参与者在基线、干预后立即、3个月和6个月时进行评估。主要结果为儿童日常注意力测试(TEA-Ch)的天空搜索子测试的注意得分。次要结果是儿童行为和父母相关的评估。采用线性混合模型评估MYmind与CBT的疗效。结果:MYmind和CBT均能显著改善儿童6个月时的注意力评分(MYmind: β = 1.48, p = 0.013, Cohen’s d = 0.32;CBT: β = 1.46, p = 0.008, d = 0.27)。组内大多数次要结果均有显著改善。两组在任何时间点的主要或次要结局均无显著差异。结论:MYmind和CBT似乎都能改善儿童的注意力和行为结果,尽管这两种干预措施之间没有发现差异。这是迄今为止比较MYmind和CBT的最大的随机对照试验,尽管在大流行期间失去了后续评估。需要进一步采用非劣效性设计的随机对照试验来验证结果。
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引用次数: 0
Illness Denial in Medical Conditions: The Time Has Come to Include It in DSM Iterations. 医疗条件中的疾病否认:将其纳入 DSM 版本的时机已到。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 Epub Date: 2023-09-05 DOI: 10.1159/000533287
Thomas N Wise
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引用次数: 0
Longitudinal Development of Symptoms and Staging in Psychiatry and Clinical Psychology: A Tribute to Giovanni Fava. 精神病学和临床心理学中症状和分期的纵向发展:向Giovanni Fava致敬。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 DOI: 10.1159/000527462
Ulrich Schnyder
The introduction of diagnostic manuals, such as the first mention of mental disorders in the International Classification of Diseases (ICD-6) in 1948 [1] and the Diagnostic and Statistical Manual of Mental Disorders in 1952 [2], was a big step forward in the fields of psychiatry and clinical psychology. The operationalization of diagnostic criteria for mental disorders such as depression or schizophrenia, which lacked characteristic morphological features or laboratory biomarkers, greatly increased the reliability of clinicians’ diagnoses and their capacity to communicate with one another. However, those classifications were based on a cross-sectional view and informed clinicians, researchers, patients, and their relatives only little about the expected longitudinal course and development of a mental disorder. More specifically, cross-sectional diagnostics did not inform about trajectories of symptom severity over time, individual characteristics and combinations of symptoms, or comorbidities. Such elements are important when it comes to developing a sequential treatment plan and adjusting it as illness characteristics and symptom levels change over time. As early as 1967, Feinstein encouraged clinicians to develop their own “basic science” to use clinical phenomena and data to generate classification systems and to ultimately analyze the clinical process quantitatively [3]. Feinstein appears to have been a lone voice calling in the wilderness at that time though.
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引用次数: 2
Patients as Health Producers: The Psychosomatic Foundation of Lifestyle Medicine. 作为健康生产者的病人:生活方式医学的心身基础。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 DOI: 10.1159/000529953
Giovanni A Fava
N/A.
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引用次数: 4
Virtual Reality Exposure to a Healthy Weight Body Is a Promising Adjunct Treatment for Anorexia Nervosa. 虚拟现实暴露于健康体重的身体是一种有希望的神经性厌食症辅助治疗。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 DOI: 10.1159/000530932
Simone C Behrens, Joachim Tesch, Philine J B Sun, Sebastian Starke, Michael J Black, Hannah Schneider, Jacopo Pruccoli, Stephan Zipfel, Katrin E Giel

Introduction/objective: Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN.

Methods: In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN.

Results: In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration.

Conclusions: VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects.

简介/目的:神经性厌食症(AN)的治疗效果一般,对体重增加的恐惧是治疗结果和复发的一个强有力的预测因素。在这里,我们提出了一个虚拟现实(VR)设置暴露于健康体重,并评估其作为an辅助治疗的潜力。方法:在两项研究中,我们调查了20名高度体重或身材担忧的女性和20名AN女性的VR体验和VR暴露于更高体重的临床效果。结果:在研究1中,90%的参与者(18/20)报告了高度兴奋的症状,但口头表达了低到中等程度的恐惧。研究2表明,VR暴露在健康体重下会引起AN患者的高唤醒,并产生了一种趋势,即四次暴露可以改善对体重增加的恐惧。探索性分析揭示了三组个体对暴露的反应,这需要进一步的探索。结论:VR暴露是引起AN患者体重增加恐惧的一种被广泛接受的强大工具。我们观察到一种统计趋势,即重复虚拟暴露于健康体重的环境中,可以改善对体重增加的恐惧,而且效果显著。需要进一步的研究来确定其机制和差异效应。
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引用次数: 3
期刊
Psychotherapy and Psychosomatics
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