Pub Date : 2025-02-28DOI: 10.1016/j.psychres.2025.116422
Gianluca Rosso , Giorgia Porceddu , Caterina Portaluppi , Camilla Garrone , Gabriele Di Salvo , Giuseppe Maina
Aim
This cross-sectional observational study aimed to assess objective and subjective cognitive deficits in patients with unipolar (UD) and bipolar depression (BD), focusing on their insight into actual cognitive abilities.
Methods
A total of 124 participants were recruited: 84 patients with a current major depressive episode (43 with UD, 41 with BD) and 40 age- and gender-matched healthy controls. Cognitive assessments were conducted using the Screen for Cognitive Impairment in Psychiatry (SCIP) for objective evaluation and the Perceived Deficits Questionnaire-Depression-5-item (PDQ-d-5) for subjective assessment. Comparisons were performed using χ² tests for categorical variables and ANCOVA for continuous variables (to compare the severity of cognitive complaints and impairment, while controlling for illness duration and age at onset). The Pearson correlation coefficient was used to examine the relationship between subjective and objective measures.
Results
In the objective assessment, 72.1 % of UD patients and 68.3 % of BD patients showed cognitive symptoms, with nearly half classified as moderate to severe. No significant differences were found between UD and BD in objective cognitive profiles. In subjective assessments, 39.5 % of UD patients and 46.3 % of BD patients scored below the median. BD patients reported worse subjective cognitive performance than UD patients, with lower total scores (11.1 ± 3.2 vs. 7.9 ± 4.4, p < < 0.001) and poorer performance in planning (2.8 ± 1.5 vs. 1.9 ± 1.4, p < < 0.001) and attention (3.4 ± 0.9 vs. 2.3 ± 1.5, p < .001) domains.
Conclusion
This study confirms significant cognitive symptoms in both UD and BD patients. The discrepancy between subjective and objective cognitive performance in BD patients suggests a disconnect between perceived and cognitive abilities.
{"title":"Exploring cognitive symptoms in patients with unipolar and bipolar major depression: A comparative evaluation of subjective and objective performance","authors":"Gianluca Rosso , Giorgia Porceddu , Caterina Portaluppi , Camilla Garrone , Gabriele Di Salvo , Giuseppe Maina","doi":"10.1016/j.psychres.2025.116422","DOIUrl":"10.1016/j.psychres.2025.116422","url":null,"abstract":"<div><h3>Aim</h3><div>This cross-sectional observational study aimed to assess objective and subjective cognitive deficits in patients with unipolar (UD) and bipolar depression (BD), focusing on their insight into actual cognitive abilities.</div></div><div><h3>Methods</h3><div>A total of 124 participants were recruited: 84 patients with a current major depressive episode (43 with UD, 41 with BD) and 40 age- and gender-matched healthy controls. Cognitive assessments were conducted using the Screen for Cognitive Impairment in Psychiatry (SCIP) for objective evaluation and the Perceived Deficits Questionnaire-Depression-5-item (PDQ-<span>d</span>-5) for subjective assessment. Comparisons were performed using χ² tests for categorical variables and ANCOVA for continuous variables (to compare the severity of cognitive complaints and impairment, while controlling for illness duration and age at onset). The Pearson correlation coefficient was used to examine the relationship between subjective and objective measures.</div></div><div><h3>Results</h3><div>In the objective assessment, 72.1 % of UD patients and 68.3 % of BD patients showed cognitive symptoms, with nearly half classified as moderate to severe. No significant differences were found between UD and BD in objective cognitive profiles. In subjective assessments, 39.5 % of UD patients and 46.3 % of BD patients scored below the median. BD patients reported worse subjective cognitive performance than UD patients, with lower total scores (11.1 ± 3.2 vs. 7.9 ± 4.4, <em>p <</em> < 0.001) and poorer performance in planning (2.8 ± 1.5 vs. 1.9 ± 1.4, <em>p <</em> < 0.001) and attention (3.4 ± 0.9 vs. 2.3 ± 1.5, <em>p <</em> .001) domains.</div></div><div><h3>Conclusion</h3><div>This study confirms significant cognitive symptoms in both UD and BD patients. The discrepancy between subjective and objective cognitive performance in BD patients suggests a disconnect between perceived and cognitive abilities.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116422"},"PeriodicalIF":4.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1016/j.psychres.2025.116391
Hilary Coon , Andrey A. Shabalin , Emily DiBlasi , Eric T. Monson , Seonggyun Han , Erin A. Kaufman , Danli Chen , Brent Kious , Nicolette Molina , Zhe Yu , Michael J. Staley , David K. Crockett , Sarah M. Colbert , Niamh Mullins , Amanda V. Bakian , Anna R. Docherty , Brooks R. Keeshin
Nonfatal suicidal behavior is the most robust predictor of suicide death. However, only ∼10 % of those who survive an attempt go on to die by suicide. Moreover, ∼50 % of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified to help prevent suicide mortality. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of suicide deaths without prior nonfatal attempts. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidal ideation or behaviors (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer overall diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were far less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB, and suggest that, for a substantial number of individuals at risk for suicide mortality, history of SI/SB does not serve as an effective clinical marker of risk.
{"title":"Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks","authors":"Hilary Coon , Andrey A. Shabalin , Emily DiBlasi , Eric T. Monson , Seonggyun Han , Erin A. Kaufman , Danli Chen , Brent Kious , Nicolette Molina , Zhe Yu , Michael J. Staley , David K. Crockett , Sarah M. Colbert , Niamh Mullins , Amanda V. Bakian , Anna R. Docherty , Brooks R. Keeshin","doi":"10.1016/j.psychres.2025.116391","DOIUrl":"10.1016/j.psychres.2025.116391","url":null,"abstract":"<div><div>Nonfatal suicidal behavior is the most robust predictor of suicide death. However, only ∼10 % of those who survive an attempt go on to die by suicide. Moreover, ∼50 % of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified to help prevent suicide mortality. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of suicide deaths without prior nonfatal attempts. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidal ideation or behaviors (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer overall diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were far less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB, and suggest that, for a substantial number of individuals at risk for suicide mortality, history of SI/SB does not serve as an effective clinical marker of risk.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116391"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.psychres.2025.116410
John Paliakkara , Stacy Ellenberg , Andrew Ursino , Abigail A Smith , James Evans , Joseph Strayhorn , Stephen V. Faraone , Yanli Zhang-James
Intermittent Explosive Disorder (IED) is characterized by repeated inability to control aggressive impulses. Although the etiology and neurobiology of impulsive anger and impulse control disorders have been reviewed, no systematic review on these aspects has been published for IED specifically. We conducted a systematic search in seven electronic databases for publications about IED, screened by two authors, and retained twenty-four studies for the review. Our findings highlight a multifactorial etiology and neurobiology of IED, emphasizing the role of the amygdala and orbitofrontal cortex in emotional regulation and impulse control, and supporting interventions that target serotonergic signaling. Research also shows that childhood trauma and adverse family environment may significantly contribute to the development of IED. Yet, genetic studies focusing on IED were largely lacking, despite many examining the genetics underlying aggression as a general trait or other related disorders. Future research using consistently defined IED as a phenotype is required to better understand the etiology and underlying mechanisms and assist in informing the development of more effective interventions for IED.
{"title":"A systematic review of the etiology and neurobiology of intermittent explosive disorder","authors":"John Paliakkara , Stacy Ellenberg , Andrew Ursino , Abigail A Smith , James Evans , Joseph Strayhorn , Stephen V. Faraone , Yanli Zhang-James","doi":"10.1016/j.psychres.2025.116410","DOIUrl":"10.1016/j.psychres.2025.116410","url":null,"abstract":"<div><div>Intermittent Explosive Disorder (IED) is characterized by repeated inability to control aggressive impulses. Although the etiology and neurobiology of impulsive anger and impulse control disorders have been reviewed, no systematic review on these aspects has been published for IED specifically. We conducted a systematic search in seven electronic databases for publications about IED, screened by two authors, and retained twenty-four studies for the review. Our findings highlight a multifactorial etiology and neurobiology of IED, emphasizing the role of the amygdala and orbitofrontal cortex in emotional regulation and impulse control, and supporting interventions that target serotonergic signaling. Research also shows that childhood trauma and adverse family environment may significantly contribute to the development of IED. Yet, genetic studies focusing on IED were largely lacking, despite many examining the genetics underlying aggression as a general trait or other related disorders. Future research using consistently defined IED as a phenotype is required to better understand the etiology and underlying mechanisms and assist in informing the development of more effective interventions for IED.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116410"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.psychres.2025.116413
Shivani Jaiswal , Swapnajeet Sahoo , Vandana Dhiman , Naresh Sachdeva , Mini P Singh , Sant Ram , Gaurav Sharma , Sanjay Kumar Bhadada
Background: A significant percentage of COVID-19 survivors experience long-term neuropsychiatric and physical issues. Baseline biochemical parameters may be linked to these psychiatric sequelae.
Aim: This study aimed to explore the association between baseline biochemical parameters and psychiatric outcomes in COVID-19 survivors three years post-infection.
Methods: We enrolled 100 COVID-19 survivors (mild and severe) and conducted comprehensive biochemical, endocrine, and psychiatric evaluations using peripheral blood samples and psychological assessments (GAD-7, PHQ-9, MoCA, ISI) at 3 years of follow-up assessment. Tau protein levels were measured at follow-up. Baseline biochemical data were retrieved from medical records, and linear regression analysis was used to identify predictors of psychiatric symptoms.
Results: HbA1c levels were significantly higher in severe cases at baseline (7.08±2.11 vs. 6.22±1.62) and follow-up (6.54±2.01 vs. 5.78±1.07). Severe cases also had elevated p-tau protein levels (99.34±120 vs. 59.7 ± 45.9). Low sodium and potassium at baseline were negatively correlated with anxiety and depression scores, predicting anxiety (8 %) and depressive symptoms (6 %) in mild cases. Low calcium predicted depressive (10 %) and anxiety symptoms (7.5 %) across all cases.
Conclusion: COVID-19 survivors with a history of severe infection displayed higher p-tau and HbA1c levels, indicating potential new-onset diabetes and neuronal damage. Electrolyte imbalances, particularly sodium, potassium, and calcium, during acute infection predicted long-term psychiatric symptoms, including depression, anxiety, and somatization.
{"title":"Long COVID psychiatric sequelae, biochemical markers & tau protein: A 3-year follow-up study","authors":"Shivani Jaiswal , Swapnajeet Sahoo , Vandana Dhiman , Naresh Sachdeva , Mini P Singh , Sant Ram , Gaurav Sharma , Sanjay Kumar Bhadada","doi":"10.1016/j.psychres.2025.116413","DOIUrl":"10.1016/j.psychres.2025.116413","url":null,"abstract":"<div><div>Background: A significant percentage of COVID-19 survivors experience long-term neuropsychiatric and physical issues. Baseline biochemical parameters may be linked to these psychiatric sequelae.</div><div>Aim: This study aimed to explore the association between baseline biochemical parameters and psychiatric outcomes in COVID-19 survivors three years post-infection.</div><div>Methods: We enrolled 100 COVID-19 survivors (mild and severe) and conducted comprehensive biochemical, endocrine, and psychiatric evaluations using peripheral blood samples and psychological assessments (GAD-7, PHQ-9, MoCA, ISI) at 3 years of follow-up assessment. Tau protein levels were measured at follow-up. Baseline biochemical data were retrieved from medical records, and linear regression analysis was used to identify predictors of psychiatric symptoms.</div><div>Results: HbA1c levels were significantly higher in severe cases at baseline (7.08±2.11 vs. 6.22±1.62) and follow-up (6.54±2.01 vs. 5.78±1.07). Severe cases also had elevated p-tau protein levels (99.34±120 vs. 59.7 ± 45.9). Low sodium and potassium at baseline were negatively correlated with anxiety and depression scores, predicting anxiety (8 %) and depressive symptoms (6 %) in mild cases. Low calcium predicted depressive (10 %) and anxiety symptoms (7.5 %) across all cases.</div><div>Conclusion: COVID-19 survivors with a history of severe infection displayed higher p-tau and HbA1c levels, indicating potential new-onset diabetes and neuronal damage. Electrolyte imbalances, particularly sodium, potassium, and calcium, during acute infection predicted long-term psychiatric symptoms, including depression, anxiety, and somatization.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116413"},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.psychres.2025.116412
Claudia Liu, Jake Linardon
Smartphone apps have the potential to play an integral role in the management of eating disorders. However, despite evidence of efficacy, apps have yet to be widely adopted and integrated into clinical practice. This study sought to understand mental health clinicians’ practices and perspectives of eating disorder apps. One-hundred-eighteen mental health clinicians (67 % Psychologists, 10 % Psychiatrists, 10 % Counsellors, 6 % Psychiatric Nurses; 7 % other) responded to a survey assessing current practices, knowledge, and attitudes related to apps in practice. Nearly two-thirds of clinicians (63 %) had used/discussed apps with clients; the most common reasons were that apps complement their services (80 % endorsed) and are efficient methods for monitoring symptoms and progress (89 % endorsed). The most common reason for clinicians who had not used/discussed apps with clients was not knowing which apps were appropriate to recommend (82 % endorsed). Nearly 50 % of clinicians reported little to no knowledge of current eating disorder apps, as well as limited confidence in using them effectively in practice. However, 8 in 10 clinicians were open to incorporating apps in treatment, and most agreed that apps can be beneficial for psychoeducation, skill utilization, relapse prevention, and offering support when access to other help options is limited. Overall, findings show that clinicians are enthusiastic about the potential of apps to assist in the management of eating disorders, but clear barriers to their adoption and integration in practice remain. We outline actionable strategies aimed at addressing these barriers and facilitating the broader integration of eating disorder apps into practice.
{"title":"Mental health clinicians’ practices and perspectives of eating disorder apps","authors":"Claudia Liu, Jake Linardon","doi":"10.1016/j.psychres.2025.116412","DOIUrl":"10.1016/j.psychres.2025.116412","url":null,"abstract":"<div><div>Smartphone apps have the potential to play an integral role in the management of eating disorders. However, despite evidence of efficacy, apps have yet to be widely adopted and integrated into clinical practice. This study sought to understand mental health clinicians’ practices and perspectives of eating disorder apps. One-hundred-eighteen mental health clinicians (67 % Psychologists, 10 % Psychiatrists, 10 % Counsellors, 6 % Psychiatric Nurses; 7 % other) responded to a survey assessing current practices, knowledge, and attitudes related to apps in practice. Nearly two-thirds of clinicians (63 %) had used/discussed apps with clients; the most common reasons were that apps complement their services (80 % endorsed) and are efficient methods for monitoring symptoms and progress (89 % endorsed). The most common reason for clinicians who had not used/discussed apps with clients was not knowing which apps were appropriate to recommend (82 % endorsed). Nearly 50 % of clinicians reported little to no knowledge of current eating disorder apps, as well as limited confidence in using them effectively in practice. However, 8 in 10 clinicians were open to incorporating apps in treatment, and most agreed that apps can be beneficial for psychoeducation, skill utilization, relapse prevention, and offering support when access to other help options is limited. Overall, findings show that clinicians are enthusiastic about the potential of apps to assist in the management of eating disorders, but clear barriers to their adoption and integration in practice remain. We outline actionable strategies aimed at addressing these barriers and facilitating the broader integration of eating disorder apps into practice.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116412"},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.psychres.2025.116405
Ruitong Li , Yuchuan Yue , Xujie Gu , Lingling Xiong , Meiqi Luo , Ling Li
<div><h3>Background</h3><div>Adolescence is recognized as a high-risk period for suicide, with the prevalence of suicide risk among adolescents rising globally, positioning it as one of the most urgent public health concerns worldwide. This study systematically reviews and evaluates adolescent suicide risk prediction models, identifies key predictors, and offers valuable insights for the development of future tools to assess suicide risk in adolescents.</div></div><div><h3>Methods</h3><div>We systematically searched four international databases (PubMed, Web of Science, Embase, and Cochrane Libraries) and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu Libraries) up to May 14, 2024. Two researchers independently screened the literature, extracted data, and evaluated the model quality using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata17.0 and R4.4.2 softwares were used to conduct meta-analysis.</div></div><div><h3>Results</h3><div>25 studies involving 62 prediction models were included, of which 51 models were internally validated with an area under the curve (AUC) > 0.7. The researchers mainly used modeling methods such as logistic regression (LR), random forest (RF), extreme gradient boosting (XGBoost), decision tree (DT), and support vector machine (SVM). 22 studies performed internal validation of the model, while only 3 had undergone external validation. The models developed in all 25 studies demonstrated good applicability, 19 studies showed a high risk of bias, primarily due to inappropriate data sources and poor reporting of the analysis domain. Meta-analysis results showed that the pooled AUC for internal validation of 28 adolescent suicide risk prediction models was 0.846 (95 %CI=0.828–0.866), while the AUC for external validation of 2 models was 0.810 (95 %CI=0.704–0.932). The detection rate of suicide risk among adolescents was 22.5 % (95 %CI=18.0 %-27.0 %), gender(OR=1.490,95 %CI=1.217–1.824), depressive symptoms (OR=3.175,95 %CI=1.697–5.940), stress level (OR=2.436,95 %CI=1.019–5.819), previous suicidal ideation (OR=1.772,95 %CI=1.640–1.915), previous self-injurious behaviors (OR=4.138,95 %CI=1.328–12.895), drug abuse(OR=3.316,95 %CI=1.537–7.154), history of bullying(OR=3.417,95 %CI=2.567–4.547), and family relationships (OR=1.782,95 %CI=1.115–2.849) were independent influences on adolescent suicide risk (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>The adolescent suicide risk prediction model demonstrated excellent predictive performance. However, given the high risk of bias in most studies and the insufficient external validation, its clinical applicability requires further investigation. Future studies on adolescent suicide risk prediction models should focus on predictors, including gender, depressive symptoms, stress level, previous suicidal ideation, previous self-injurious behaviors, drug abuse, history of bull
{"title":"Risk prediction models for adolescent suicide: A systematic review and meta-analysis","authors":"Ruitong Li , Yuchuan Yue , Xujie Gu , Lingling Xiong , Meiqi Luo , Ling Li","doi":"10.1016/j.psychres.2025.116405","DOIUrl":"10.1016/j.psychres.2025.116405","url":null,"abstract":"<div><h3>Background</h3><div>Adolescence is recognized as a high-risk period for suicide, with the prevalence of suicide risk among adolescents rising globally, positioning it as one of the most urgent public health concerns worldwide. This study systematically reviews and evaluates adolescent suicide risk prediction models, identifies key predictors, and offers valuable insights for the development of future tools to assess suicide risk in adolescents.</div></div><div><h3>Methods</h3><div>We systematically searched four international databases (PubMed, Web of Science, Embase, and Cochrane Libraries) and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu Libraries) up to May 14, 2024. Two researchers independently screened the literature, extracted data, and evaluated the model quality using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata17.0 and R4.4.2 softwares were used to conduct meta-analysis.</div></div><div><h3>Results</h3><div>25 studies involving 62 prediction models were included, of which 51 models were internally validated with an area under the curve (AUC) > 0.7. The researchers mainly used modeling methods such as logistic regression (LR), random forest (RF), extreme gradient boosting (XGBoost), decision tree (DT), and support vector machine (SVM). 22 studies performed internal validation of the model, while only 3 had undergone external validation. The models developed in all 25 studies demonstrated good applicability, 19 studies showed a high risk of bias, primarily due to inappropriate data sources and poor reporting of the analysis domain. Meta-analysis results showed that the pooled AUC for internal validation of 28 adolescent suicide risk prediction models was 0.846 (95 %CI=0.828–0.866), while the AUC for external validation of 2 models was 0.810 (95 %CI=0.704–0.932). The detection rate of suicide risk among adolescents was 22.5 % (95 %CI=18.0 %-27.0 %), gender(OR=1.490,95 %CI=1.217–1.824), depressive symptoms (OR=3.175,95 %CI=1.697–5.940), stress level (OR=2.436,95 %CI=1.019–5.819), previous suicidal ideation (OR=1.772,95 %CI=1.640–1.915), previous self-injurious behaviors (OR=4.138,95 %CI=1.328–12.895), drug abuse(OR=3.316,95 %CI=1.537–7.154), history of bullying(OR=3.417,95 %CI=2.567–4.547), and family relationships (OR=1.782,95 %CI=1.115–2.849) were independent influences on adolescent suicide risk (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>The adolescent suicide risk prediction model demonstrated excellent predictive performance. However, given the high risk of bias in most studies and the insufficient external validation, its clinical applicability requires further investigation. Future studies on adolescent suicide risk prediction models should focus on predictors, including gender, depressive symptoms, stress level, previous suicidal ideation, previous self-injurious behaviors, drug abuse, history of bull","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116405"},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.psychres.2025.116409
A. Solberg , A. Ottesen , EA Barrett , I. Kristiansen , E. Mork , P. Qin , I. Melle
Background
Many risk factors for suicidal behavior (SB) in schizophrenia spectrum disorders (SSD) are present before the onset of psychosis or are associated with specific phases of illness. We aim to investigate the trajectories of SB from before the onset of psychosis until the first start of treatment in patients with first-episode psychosis (FEP).
Method
A total of 252 patients with first-episode SSD were recruited, out of which 224 had complete SB data. They participated in clinical interviews and self-report questionnaires during their first treatment. We assessed SB in three time periods: Before the onset of psychosis, during untreated psychosis, and at treatment start (study baseline). We used K-mean cluster analyses to identify trajectories of SB over these periods.
Results
Four trajectories of SB were identified: persistent low/no SB (n = 114, 51 % of 224), increasing mild/moderate SB (n = 54, 24 %), severe SB during untreated psychosis (n = 25, 11 %), severe persistent SB (n = 31, 14 %). With “persistent low/no SB” as a reference group, all other groups had significantly more depressive symptoms at baseline. The duration of untreated psychosis was significantly longer in the group with “severe SB during untreated psychosis”. Clinical insight subscale scores differed between the trajectory groups. Also, the “severe persistent SB” group reported more emotional abuse and total childhood trauma than the “increasing mild/moderate SB” group.
Conclusion
Our findings suggest the presence of different pathways to SB in FEP. More knowledge about these pathways can support the development of tailored preventive strategies in this patient group.
{"title":"Trajectories of suicidal behavior and their clinical correlates in the early phases of schizophrenia spectrum disorders","authors":"A. Solberg , A. Ottesen , EA Barrett , I. Kristiansen , E. Mork , P. Qin , I. Melle","doi":"10.1016/j.psychres.2025.116409","DOIUrl":"10.1016/j.psychres.2025.116409","url":null,"abstract":"<div><h3>Background</h3><div>Many risk factors for suicidal behavior (SB) in schizophrenia spectrum disorders (SSD) are present before the onset of psychosis or are associated with specific phases of illness. We aim to investigate the trajectories of SB from before the onset of psychosis until the first start of treatment in patients with first-episode psychosis (FEP).</div></div><div><h3>Method</h3><div>A total of 252 patients with first-episode SSD were recruited, out of which 224 had complete SB data. They participated in clinical interviews and self-report questionnaires during their first treatment. We assessed SB in three time periods: Before the onset of psychosis, during untreated psychosis, and at treatment start (study baseline). We used K-mean cluster analyses to identify trajectories of SB over these periods.</div></div><div><h3>Results</h3><div>Four trajectories of SB were identified: persistent low/no SB (n = 114, 51 % of 224), increasing mild/moderate SB (n = 54, 24 %), severe SB during untreated psychosis (n = 25, 11 %), severe persistent SB (n = 31, 14 %). With “persistent low/no SB” as a reference group, all other groups had significantly more depressive symptoms at baseline. The duration of untreated psychosis was significantly longer in the group with “severe SB during untreated psychosis”. Clinical insight subscale scores differed between the trajectory groups. Also, the “severe persistent SB” group reported more emotional abuse and total childhood trauma than the “increasing mild/moderate SB” group.</div></div><div><h3>Conclusion</h3><div>Our findings suggest the presence of different pathways to SB in FEP. More knowledge about these pathways can support the development of tailored preventive strategies in this patient group.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116409"},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.psychres.2025.116408
Jose de Leon , Marina Sagud , Emilio J. Sanz , Carlos De las Cuevas
Croatia has implemented anti-suicide measures due to its high suicide rates. Clozapine has anti-suicidal effects. Using the international database (VigiBase), we explored Croatia's unusual clozapine pharmacovigilance. First, we compared the United Kingdom (UK) with Croatia for clozapine adverse drug reactions (ADRs) and fatal outcomes from clozapine's introduction through January 15, 2023. If the UK is considered 1, and after adjusting for population, Croatia had much lower rates (1 vs. 0.08 for clozapine ADR reports, 1 vs. 0.02 for fatal outcomes and 1 vs. 0.14 for percentage of clozapine reports out of all drug reports). Through 2023, the UK had 52,252 ADR reports and 6,567 fatal outcomes from clozapine-treated patients vs. Croatia with 395 reports and 6 fatal outcomes. The Croatian pharmacovigilance agency (and most national agencies) needs to learn from the UK's agency to better report clozapine ADRs. Second, we analyze suicide behaviors in Croatian clozapine-treated patients reported to VigiBase. Through 2023 the UK reported 537 clozapine-treated patients with at least 1 suicidal behavior versus 95 from Croatia. After adjusting for population, the UK reported a much smaller number of reports of suicidal behavior than Croatia (1 vs. 2.73). This overreporting by Croatian physicians may be a sign of the success of Croatia's anti-suicide measures. The percentage of fatal outcomes in 77 Croatian patients with an intentional overdose was 1.3 % (1/77) vs. 16.8 % in 411 non-Croatian patients, but this is possibly contaminated by early reporting (patients might die after the report). Longitudinal studies of clozapine overdoses in Croatia are needed.
{"title":"Clozapine pharmacovigilance in Croatia: Underreporting of specific adverse drug reactions and excellent reporting of suicide attempts","authors":"Jose de Leon , Marina Sagud , Emilio J. Sanz , Carlos De las Cuevas","doi":"10.1016/j.psychres.2025.116408","DOIUrl":"10.1016/j.psychres.2025.116408","url":null,"abstract":"<div><div>Croatia has implemented anti-suicide measures due to its high suicide rates. Clozapine has anti-suicidal effects. Using the international database (VigiBase), we explored Croatia's unusual clozapine pharmacovigilance. First, we compared the United Kingdom (UK) with Croatia for clozapine adverse drug reactions (ADRs) and fatal outcomes from clozapine's introduction through January 15, 2023. If the UK is considered 1, and after adjusting for population, Croatia had much lower rates (1 vs. 0.08 for clozapine ADR reports, 1 vs. 0.02 for fatal outcomes and 1 vs. 0.14 for percentage of clozapine reports out of all drug reports). Through 2023, the UK had 52,252 ADR reports and 6,567 fatal outcomes from clozapine-treated patients vs. Croatia with 395 reports and 6 fatal outcomes. The Croatian pharmacovigilance agency (and most national agencies) needs to learn from the UK's agency to better report clozapine ADRs. Second, we analyze suicide behaviors in Croatian clozapine-treated patients reported to VigiBase. Through 2023 the UK reported 537 clozapine-treated patients with at least 1 suicidal behavior versus 95 from Croatia. After adjusting for population, the UK reported a much smaller number of reports of suicidal behavior than Croatia (1 vs. 2.73). This overreporting by Croatian physicians may be a sign of the success of Croatia's anti-suicide measures. The percentage of fatal outcomes in 77 Croatian patients with an intentional overdose was 1.3 % (1/77) vs. 16.8 % in 411 non-Croatian patients, but this is possibly contaminated by early reporting (patients might die after the report). Longitudinal studies of clozapine overdoses in Croatia are needed.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116408"},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.psychres.2025.116406
Stefano Damiani , Aldo D'Imperio , Joaquim Radua , Lydia Fortea , Matteo Calò , Andrea Crippa , Cecilia Maria Esposito , Estella Linda Luisa Lumer , Sara Patron , Alessandro Peviani , Alessandro Piccolo , Umberto Provenzani , Fabrizio Santilli , Cecilia Spallarossa , Laura Fusar-Poli , Evangelos Papanastasiou , Matteo Cella , Rashmi Patel , Silvana Galderisi , Stefan Leucht , Paolo Fusar-Poli
Negative symptoms in schizophrenia spectrum are associated with minimal treatment responses. The search for effective treatments is potentially hampered by heterogenous study-designs and sample characteristics depending on the intervention category. This PRISMA-compliant systematic review/synthesis aims to describe the literature on negative symptoms interventions for schizophrenia spectrum disorders by comparing 12 study design, demographical and clinical variables in different intervention categories: antipsychotics (AP), other pharmacological agents (OPA), brain stimulation (BS), psychological/psychosocial (PSI), lifestyle (LS), mixed interventions. Kruskal-Wallis and Chi-square tests measured differences between intervention-groups. Out of 19,935 articles, 489 (AP=149/OPA=187/BS=49/PSI=79/LS=19/mixed=6) were selected for data extraction. Concerning study designs, AP had the largest average arm size (mean ± SD=91.1 ± 122.8participants), OPA the highest double/triple-blinding (97.9 %) rates, PSI the longest follow-up (26.7 ± 21.8weeks). Age/gender demographical differences were significant but of negligible magnitude. OPA illness duration (14.8 ± 9.0years) was longer compared to AP (11.4 ± 6.7years). Positive and Negative Syndrome Scale (PANSS) negative scores were milder in PSI (18.6 ± 6.9) compared to AP/OPA/BS (23.8 ± 6.4/23.4 ± 4.9/24.2 ± 9.2). PANSS total scores were worse in AP (83.6 ± 18.2) than in OPA/BS/PSI (77.1 ± 20.5/75.5 ± 14.7/67.0 ± 23.3). The same was true for dropout rates (AP=25.5 %, OPA/BS/PSI=14.3/9.7/14.5 %). Prevalent treatment as usual was “none” for AP (36.7 %) and “antipsychotic” for other categories (42.3–82.8 %). Implementing cross-over, factorial or multi-arm designs may increase the comparability between studies investigating different intervention categories. Concerning clinical differences, reporting individual treatments at baseline and clinical severity, evaluating cognitive profiles and considering patients’ perspectives will allow to better understand the efficacy of the available treatments and develop tailored interventions.
{"title":"A systematic review and synthesis of 489 studies investigating treatments for negative symptoms in the schizophrenia spectrum: Trial designs, demographics and clinical characteristics","authors":"Stefano Damiani , Aldo D'Imperio , Joaquim Radua , Lydia Fortea , Matteo Calò , Andrea Crippa , Cecilia Maria Esposito , Estella Linda Luisa Lumer , Sara Patron , Alessandro Peviani , Alessandro Piccolo , Umberto Provenzani , Fabrizio Santilli , Cecilia Spallarossa , Laura Fusar-Poli , Evangelos Papanastasiou , Matteo Cella , Rashmi Patel , Silvana Galderisi , Stefan Leucht , Paolo Fusar-Poli","doi":"10.1016/j.psychres.2025.116406","DOIUrl":"10.1016/j.psychres.2025.116406","url":null,"abstract":"<div><div>Negative symptoms in schizophrenia spectrum are associated with minimal treatment responses. The search for effective treatments is potentially hampered by heterogenous study-designs and sample characteristics depending on the intervention category. This PRISMA-compliant systematic review/synthesis aims to describe the literature on negative symptoms interventions for schizophrenia spectrum disorders by comparing 12 study design, demographical and clinical variables in different intervention categories: antipsychotics (AP), other pharmacological agents (OPA), brain stimulation (BS), psychological/psychosocial (PSI), lifestyle (LS), mixed interventions. Kruskal-Wallis and Chi-square tests measured differences between intervention-groups. Out of 19,935 articles, 489 (AP=149/OPA=187/BS=49/PSI=79/LS=19/mixed=6) were selected for data extraction. Concerning study designs, AP had the largest average arm size (mean ± SD=91.1 ± 122.8participants), OPA the highest double/triple-blinding (97.9 %) rates, PSI the longest follow-up (26.7 ± 21.8weeks). Age/gender demographical differences were significant but of negligible magnitude. OPA illness duration (14.8 ± 9.0years) was longer compared to AP (11.4 ± 6.7years). Positive and Negative Syndrome Scale (PANSS) negative scores were milder in PSI (18.6 ± 6.9) compared to AP/OPA/BS (23.8 ± 6.4/23.4 ± 4.9/24.2 ± 9.2). PANSS total scores were worse in AP (83.6 ± 18.2) than in OPA/BS/PSI (77.1 ± 20.5/75.5 ± 14.7/67.0 ± 23.3). The same was true for dropout rates (AP=25.5 %, OPA/BS/PSI=14.3/9.7/14.5 %). Prevalent treatment as usual was “none” for AP (36.7 %) and “antipsychotic” for other categories (42.3–82.8 %). Implementing cross-over, factorial or multi-arm designs may increase the comparability between studies investigating different intervention categories. Concerning clinical differences, reporting individual treatments at baseline and clinical severity, evaluating cognitive profiles and considering patients’ perspectives will allow to better understand the efficacy of the available treatments and develop tailored interventions.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"347 ","pages":"Article 116406"},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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