Psychiatry and Clinical Psychopharmacology最新文献

Catatonia is a transdiagnostic syndrome observed across psychiatric, medical, and developmental disorders. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), it is not classified as a stand-alone disorder but as a specifier or syndrome that accompanies other conditions. This review examines the current state of knowledge on catatonia in children, adolescents, and individuals with neurodevelopmental disorders, particularly autism spectrum disorder and intellectual developmental disorders. Several DSM-5-TR criteria overlap with baseline behaviors in these populations, creating a risk of false-positive diagnoses. To improve specificity, a refined framework that requires at least 2 of 5 core signs-stupor/immobility, new-onset mutism, posturing or catalepsy with waxy flexibility, severe negativism or withdrawal, and stimulusindependent excitement/agitation-each demonstrably new or worsened from baseline is proposed. The Bush-Francis Catatonia Rating Scale and its Pediatric Catatonia Rating Scale adaptation is reviewed, highlighting their limitations in developmental contexts. Catatonia typologies relevant to neurodevelopmental conditions are also outlined, the cautious use of the lorazepam challenge test is discussed, and converging neurobiological evidence implicating gamma-aminobutyric acid, glutamate, dopamine, cortico-striato-thalamo-cortical circuitry, and immune mechanisms is summarized. Future directions include psychometric validation of pediatric tools, empirical item reduction, integration of biomarkers, and treatment prediction studies to refine developmental assessment and clinical care.

Background: Delirium is a common problem in critically ill patients, and it can increase mortality; however, the epidemiology of delirium, especially based on motor subtypes, is not fully understood. The aim of this study was to compare and identify differences in demographics, treatments, and outcomes between delirium subtypes among critically ill patients with an accurate diagnosis by consultation-liaison psychiatry (CLP).

Methods: This single-center, retrospective cohort study was carried out from January 1, 2021, to December 31, 2022. All adult patients who were admitted to the intensive care unit (ICU) or high care unit (HCU) and who had been diagnosed with delirium by CLP were enrolled. The main outcome measure was all-cause in-hospital mortality. The subjects were assigned to either the hyperactive delirium group or the hypoactive/mixed delirium group, and backgrounds, treatments, and outcomes were compared between the groups.

Results: Among 1910 patients admitted to the ICU and HCU during the study period, 82 adult patients were included in this study. Of these, 62.2% had hyperactive delirium and 37.8% had hypoactive or mixed delirium. The diagnosis, vital signs at admission, and psychotropic drugs for delirium did not differ between groups. In-hospital mortality was higher in the hypoactive/mixed delirium group than in the hyperactive delirium group (16.1% vs. 2.1%; P=.027).

Conclusion: Most patient characteristics, diagnoses, severity of vital status, and medications for delirium prescribed by CLP were similar between the 2 groups. However, in-hospital mortality was higher in the hypoactive/mixed delirium group than in the hyperactive delirium group.

Background: Malnutrition is prevalent among patients with peritoneal dialysis and is closely related to psychological distress and reduced psychological flexibility. This study aimed to explore the association between psychological status and nutritional health and to evaluate the impact of acceptance and commitment therapy (ACT) on psychological and nutritional outcomes.

Methods: A total of 75 patients undergoing peritoneal dialysis were assessed for anxiety, depression, psychological flexibility, and nutritional status using self-rating anxiety scale (SAS), self-rating depression scale (SDS), acceptance and action questionnaire-2nd edition (AAQ-II), and modified quantitative subjective global assessment (MQSGA), respectively. Pearson correlation analysis was performed. In a subsequent randomized controlled trial, 52 eligible patients were divided into intervention and control groups. The control group received standard care, while the intervention group received ACT over 4 weeks. Assessments were conducted at baseline, 4 weeks, and 12 weeks.

Results: Psychological indicators (SAS, SDS, and AAQ-II) were positively correlated with malnutrition severity (MQSGA) (P < .05). The ACT significantly reduced anxiety, depression, and psychological inflexibility over time compared to controls (P < .05). Nutritional markers including transferrin saturation and hemoglobin also improved in the ACT group (P < .05).

Conclusion: The ACT is effective in improving both psychological well-being and nutritional status in patients with peritoneal dialysis. Psychological flexibility may serve as a modifiable target for nutritional rehabilitation in this population.

Background: Earthquakes are a significant natural disaster, particularly in regions where they occurfrequently. Their psychological impact can lead to heightened anxiety, especially among individualsliving in earthquake-prone areas. This study investigates the anxiety levels and preparedness behaviorsof medical students who face unique stressors due to their future roles as healthcare providers.

Methods: This cross-sectional study was conducted with 152 6th-term medical students at MarmaraUniversity Faculty of Medicine. Data were collected through a survey that included sociodemographicquestions, the Beck Anxiety Inventory, and earthquake preparedness measures based on AFAD (Disasterand Emergency Management Authority) recommendations. Statistical analysis was performed usingSPSS v25 (IBM SPSS Corp.; Armonk, NY, USA), with a significance level of P < .05.

Results: A significant portion (66.9%) of the students reported severe anxiety, while 33.1% showedmoderate anxiety. There was no significant difference between genders in anxiety levels. However,women exhibited higher preparedness levels across various items compared to men. Previousearthquake experience was significantly linked to increased preparedness behaviors. Students who hadexperienced displacement due to an earthquake showed significantly higher preparedness than thosewho had not.

Conclusion: Medical students at Marmara University displayed high levels of earthquake-relatedanxiety and inadequate preparedness. Factors such as prior earthquake experience and displacementinfluenced preparedness behaviors, while psychological support did not significantly affect anxietylevels. These findings highlight the need for enhanced disaster preparedness training and psychologicalsupport tailored to the unique challenges medical students face. Future research should explorebroader populations and the long-term impacts of preparedness education.

Background: Therapeutic drug monitoring (TDM) is an important tool to personalize psychopharmacotherapy, thereby optimizing its effectiveness and tolerability. Despite consensus on medications, indications, and implementation of TDM, reports indicate a substantial gap between theory and practice. To further investigate this gap, the current application of TDM was assessed in the adult inpatient settings of the University Hospital of Psychiatry and Psychotherapy of Bern, Switzerland.

Methods: To assess current practice in TDM, drug level measurements were analyzed in 2022. In parallel, an online survey as well as standardized interviews were conducted with the clinic's physicians. To improve TDM applications, a handout was designed with the core items of the TDM guidelines, revised the orders for TDM in the hospital information system, and held an internal lecture on TDM.

Results: In clinical practice, TDM was primarily used for clozapine, lithium, and valproate. Other drugs appear to be underrepresented. Although physicians generally rated their knowledge of TDM as good, they identified the need for improvement in medical knowledge. The main source of error in TDM was the incorrect timing of blood samples. There was disagreement among the physicians about the number of TDMs.

Conclusion: Therapeutic drug monitoring is well established for clozapine, lithium, and valproate. Compared to the international consensus, physicians applied TDM to a narrower spectrum of psychotropic drugs. Efforts are needed to improve TDM. To optimize TDM, a handout was created, and the TDM request was adapted in the hospital according to guidelines recommendations based on findings of TDM requests, the survey, and interviews.

Background: To analyze the overall response of eszopiclone plus acupuncture therapy by dispersing the stagnated liver-qi and regulating the spirit (the acupuncture therapy) for treating chronic fatigue syndrome (CFS)-related sleep disorders.

Methods: A retrospective analysis was conducted on 107 patients with CFS-induced sleep disorders treated at the Hainan Provincial People's Hospital from February 2021 to February 2023. Among these, 50 patients who received eszopiclone tablets were collected as the control group. The remaining 57 patients who received the acupuncture therapy in addition to the treatment in the control group were collected as the observation group. The Pittsburgh Sleep Quality Index (PSQI) was adopted for evaluating sleep quality before and after treatment in both groups. Clinical overall response rate was compared between the 2 groups. An enzyme-linked immunosorbent assay was conducted for measuring fasting serum levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) prior to and post treatment. Adverse reactions in both groups were also recorded.

Results: The observation group got significantly lower PSQI scores than the control group (P < .05). The overall response rate of the observation group seemed to be higher than that of the control group (P=.063). The observation group showed significantly higher post-treatment 5-HT and BDNF levels than the control group (both P < .05). Safety profiles favored the observation group, with fewer adverse reactions reported (7.02% vs 22.00%) (P=.026).

Conclusion: Eszopiclone plus the acupuncture therapy enhances the efficacy of treating CFS-induced sleep disorders, effectively improves serum 5-HT and BDNF levels in patients, and reduces adverse reactions.

Background: Diabetic retinopathy (DR) is a major complication of diabetes that leads to visionimpairment and blindness. This study aims to assess the causal relationships between geneticallypredicted psychiatric disorders and DR risk, as well as the reverse causal effect of DR on psychiatricdisorders.

Methods: A 2-sample bidirectional Mendelian randomization (MR) analysis was conducted using geneticvariants from large-scale genome-wide association studies as instrumental variables. Exposuresincluded genetically predicted anxiety, attention deficit hyperactivity disorder (ADHD), depression,bipolar disorder, obsessive-compulsive disorder (OCD), personality disorders, and schizophrenia. Causaleffects were assessed using inverse variance weighted, MR-Egger, and weighted median methods whileaddressing pleiotropy and confounding.

Results: The MR analysis identified ADHD as a significant protective factor for DR (odds ratio [OR]=0.913,95% confidence interval (CI): 0.870-0.957, P < .001). No evidence of a causal relationship was foundbetween DR and other psychiatric disorders, including bipolar disorder (P=.335), depression (P=.188),OCD (P=.931), personality disorders (P=.465), schizophrenia (P=.314), or genetically predictedanxiety (P=.374). Additionally, reverse MR analysis found no evidence that DR causally influencesmental health disorders.

Conclusion: These findings suggest that ADHD may exert a protective causal effect on the risk ofdiabetic retinopathy, underscoring the need to further investigate ADHD-related neuroendocrine andvascular mechanisms in DR pathogenesis.

Background: The aim of this study was to explore the influence of individualized psychological nursingon the quality of life in patients with diabetes mellitus.

Methods: A single-center cohort study with an ambispective design was conducted. According to a1:1 ratio, the retrospective cohort included 48 patients from January 2022 to December 2022, whichwas the control group (CG), and the prospective cohort included 48 patients from January 2023 toDecember 2023, which was the intervention group (IG). The IG carried out individualized psychologicalintervention on the basis of routine nursing. The blood glucose control status, blood lipid metabolismindicators, negative emotions, self-management ability, and quality of life were compared betweengroups. The correlation between negative emotions, self-management ability, and quality of life aswell as mediating effect test were analyzed.

Results: After 6 months of follow-up, the differences of fasting blood glucose (FBG), 2-hour postprandialblood glucose (2hPG), glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol(HDL-C), and triglyceride before and after intervention in IG werehigher than those in CG (P < .05). The scores of Self-rating Anxiety Scale (SAS), Self-rating DepressionScale (SDS), and Diabetes Specific Quality of Life Scale (DSQL) in IG after 6 weeks and 12 weeks ofintervention and after 6 months of follow-up were lower than those in CG while the score of the Type2 Diabetes Self-Care Scale (2DSCS) was higher than that in CG (P < .05). The SAS and SDS were positivelycorrelated with DSQL (P < .001), and 2DSCS was negatively correlated with DSQL (P < .001). The SAS andSDS played a partial mediating role between 2DSCS and DSQL, and their mediating effects accountedfor 23.08% and 18.25% of the total effects respectively.

Conclusion: Individualized psychological nursing can improve the negative emotions in patients withtype 2 diabetes mellitus, and enhance self-management ability and quality of life. Negative emotionsplay a partial mediating role between self-management ability and quality of life.