Psychiatry and Clinical Psychopharmacology最新文献

Background: The precise involvement of metabolites in the pathogenesis of Childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) remains elusive. Consequently, this investigation introduces bidirectional Mendelian randomization (MR) as a tool to explore causality and underlying mechanisms.

Methods: Bidirectional MR analysis was conducted employing a comprehensive set comprising 1091 human blood metabolites and 309 metabolite ratios, systematically probing potential causal associations with JAE and CAE. Genome-wide association study (GWAS) data pertaining to these epileptic conditions were meticulously obtained from the International League Against Epilepsy (ILAE) consortium. Sensitivity analyses were rigorously performed to evaluate for heterogeneity and pleiotropy. Reverse MR analysis was also conducted to verify the direction of causality, and no significant reverse causal relationships were identified.

Results: Following rigorous genetic variant selection, significant associations were identified based on PIVW < .05, PWM < .05, and PMR-Egger < .05 criteria in MR analysis. Only 1 metabolite, (2 or 3)-decaonate levels, exhibited an association with JAE (P = .005, OR=0.987, 95% CI=0.978-0.996). Childhood absence epilepsy was associated with 5 metabolites: X-23648 (P = .012, OR=0.982, 95% CI=0.968-0.996), X-21845 levels (P = .045, OR=1.018, 95% CI=1.001-1.035), 2'-o-methylcytidine (P = .008, OR=0.995, 95% CI=0.991-1.001), 2'-o-methyluridine (P = .007, OR=0.995, 95% CI=0.99-0.999), and spermidine-topyruvate ratio (P = .014, OR=0.973, 95% CI=0.954-0.992). No evidence of reverse causality was found between JAE and CAE and the aforementioned metabolites.

Conclusion: The study establishes causal relationships between the aforementioned 6 metabolites and CAE and JAE. This integration of genomics with metabolism offers novel insights into epilepsy mechanisms and has important implications for screening and prevention.

Electroconvulsive therapy (ECT) has been employed as an effective treatment for refractory psychiatric disorders worldwide. Despite its extensive use, the occurrence of a fever following ECT has been rare and seldom documented. The reasons behind a post-ECT fever could vary; instances solely attributed to inflammation have been scarcely reported. We present the case of a 27-year-old woman diagnosed with bipolar disorder who experienced multiple fever episodes after having ECT. Diagnostic tests revealed elevated C-reactive protein (CRP) levels with no other infectious focus or possibility of neuroleptic malignant syndrome. We propose that this febrile reaction without real infection was related to inflammatory response triggered by ECT, with the release of various neurotransmitters into the brain and changes in the microsystems. Under this impression, we can speculate that it is a benign and reversible process, allowing us to continue ECT and achieve therapeutic efficacy. This might be the first report to suggest that an ECT-induced fever is related to inflammatory reactions.

Psychosis is a complicated neuropsychiatric disorder that involves disruptions in perception and thinking, often resulting in hallucinations and delusions. Diagnosing and treating psychosis can be challenging due to its overlap with conditions such as obsessive-compulsive disorder. Recent research has focused on identifying the genetic and biochemical markers of psychiatric disorders, which can aid in better diagnosis and treatment. Schizophrenia, a type of psychosis, has a strong genetic component, making family history crucial for diagnosis, especially in cases with early onset. Research on very early-onset schizophrenia is limited due to the variability in its definition. Copy number variations (CNV) in the 16p13.11 chromosomal region have been associated with various neurodevelopmental disorders, including intellectual disability, autism, epilepsy, attention deficit hyperactivity disorder, and schizophrenia. The link between 16p13.11 CNVs and these conditions underscores the multifaceted role of genetics in neurodevelopmental disorders. Since these disorders often share common neuronal circuits, genetic variations affecting one disorder can impact others. Patients with atypical manifestations of psychosis and additional conditions should have a comprehensive evaluation, including further psychiatric, neuroimaging, genetic, and other specialized diagnostic tests. Taking a multidisciplinary approach is crucial for identifying all contributing factors and developing an effective treatment plan. This case report discusses a twelve-year-old female with very early-onset schizophrenia, obsessivecompulsive symptoms, intellectual disability, and a 16p13.11 duplication. It emphasizes the need for further research and a comprehensive management approach for such complex and treatment-resistant cases, which can provide valuable insights into the underlying pathophysiology of psychotic disorders.

Background: In this study, we aimed to evaluate the effects of drug holidays during summer vacations on children with attention deficit/hyperactivity disorder (ADHD) treated with methylphenidate in terms of ADHD symptoms and emotion regulation (ER).

Methods: This single-center, naturalistic, prospective cohort study included pre-, post-, and post-drug holiday evaluations. All patients diagnosed with ADHD and included in our study were administered the Clinical Global Impression Scale, Affective Reactivity Index-parent and child, reading the mind in the eyes test (RMET), Faces test and Cognitive Emotion Regulation Questionnaire for Children 3 times. Fifty-six patients met the inclusion criteria and ten were lost to follow-up. Thirty-nine participants had complete evaluations at all time points.

Results: Both parent and self-report ratings of child irritability were significantly reduced after methylphenidate (MPH) treatment (P=.003 and .002, respectively), although they returned to baseline after drug holidays (P=.618 and .974, respectively). The use of self-blame as a cognitive emotion regulation strategy increased significantly after treatment and remained significantly elevated even after drug holidays (P=.024 and .022, respectively). Children used planning as a cognitive strategy significantly more frequently during MPH treatment (P=.034), although this elevation was temporary and returned to baseline levels after the drug holidays (P=.890). Reading the mind in the eyes test performance was significantly improved after MPH treatment and did not change after drug holidays (P=.009 and .006, respectively), while there was a tendency for facial emotion recognition abilities to improve at the last visit (P=.051).

Conclusion: Our results suggest that MPH treatment improves child- and parent-reported irritability, clinician-rated disorder severity, RMET performance, and the use of planning as a cognitive ER strategy, although only improvement in RMET performance continued after drug holidays. Our results may support the importance of continuing treatment over the holidays for most children with ADHD unless necessitated by adverse events, growth problems, or development of tolerance.

Vortioxetine, which functions as a 5-HT3, 5-HT1D, and 5-HT7 antagonist, a 5-HT1A agonist, and a 5-HT1B partial agonist, is a recently launched antidepressant approved by the United States Food and Drug Administration for treating adult major depressive disorder. Although hematological adverse effects have been associated with antidepressants, massive bleeding is a rare but potentially life-threatening complication. In this case report, we present a young woman who experienced abnormal bleeding tendencies, with manifestations including tarry stools, ecchymosis, and massive uterine bleeding, while undergoing vortioxetine treatment. Bleeding tendency improved after discontinuation of vortioxetine, recurred upon re-challenging, and resolved again after discontinuing the medication. This case study highlights the importance of closely monitoring bleeding tendencies in patients undergoing vortioxetine treatment. Physicians should exercise caution and thoroughly review medication history, especially for patients presenting with unexplained bleeding.

Background: : This study from Istanbul aimed to compare the child and adolescent psychiatric admissions and diagnosis rates between the first 3 months of the pandemic, the previous 3 months in the same year, and the same months in the previous year.

Methods: : Children and adolescents were grouped according to the admission dates. Group A, between March 11 and June 1, 2020; Group B, between January 1 and March 11, 2020; and Group C, between March 11 and June 1, 2019. Only clinical interviews and diagnoses according to Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) interview were included.

Results: : Autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD)/tic disorder, and intellectual disability (ID) diagnoses were higher in group A than in groups B and C (for ASD, 6.4%, 4.3%, and 3.6%; for OCD/tic disorder, 2.9%, 1.8%, 1.7%; for ID, 3.7%, 2.5%, and 2.1%, respectively) (P < .001). Attention-deficit hyperactivity disorder (ADHD) diagnosis was higher in group A than in only group B (59.8% and 49.7%, respectively) (P < 0.001). Depression was higher in group A than in only group C (4.1% and 2.2%, respectively) (P < .001). Conduct disorder (CD) diagnosis was lower in group A than in only group B (3.6% and 6.4%, respectively) (P < .05).

Conclusion: : Child psychiatry diagnosis rates were found to change significantly during the initial phase of the pandemic period. Among the referrals, ASD, OCD, Tic disorder, ID, ADHD, and depression admissions were significantly higher. The rate of pediatric neurodevelopmental disorders, particularly ASD, increased during the initial phase of the COVID-19 pandemic.

Background: Our study aimed to investigate the factors associated with mothers' shaking behavior of their babies.

Methods: Sixty-three mothers who stated that they shook their babies (Group B) and 91 mothers who stated that they did not (Group A) among those who applied to or were followed up from the Pediatric Outpatient Clinics of our University Hospital were included. The mothers (with a baby aged 0-30 months) completed the Brief Symptom Inventory (BSI) and psychiatric rating scales measuring attachment styles, empathic tendency, perceived social support, and self-esteem. The severity of the simulated shaking of the mothers was measured by an accelerometer placed on an infant manikin and separately scored on a Numerical Rating Scale by the researchers and an Illustrated Numeric Rating Scale by the mothers.

Results: In group B, babies' crying frequency was higher (P = .008); soothing the babies when they cried was more difficult (P = .019), mothers reported that they were exposed to physical violence more in their childhood (P = .003), BSI hostility scores (P = .004) and BSI-anxiety scores (P = .034) of the mothers were higher when compared with the group A. The age of the babies (P = .002, OR = 1.096), moderate crying frequency (P = .035, OR = 2.900), the mothers' difficulty in soothing their babies (sometimes P = .018, OR = 3.705, often/always P = .014, OR = 7.777), and the mothers' experience of physical violence in childhood (P = .002, OR = 5.674) were found to be factors affecting the shaking behavior.

Conclusion: Clarifying the factors associated with the mothers' shaking behavior of their babies would be helpful in terms of protecting future generations.

Background: It is to examine how child psychiatry admissions, diagnosis and treatment trends in the second wave (September-December 2020/SD20) of the coronavirus disease 2019 (COVID-19) pandemic change compared to the pre-pandemic (SD19) and the first wave (March-June 2020/MJ20).

Methods: Our study was planned as a multicenter, retrospective cross-sectional. Data were obtained from hospital computer systems databases. All patients admitted to the child psychiatry clinic on SD19 and SD20 constituted the study sample. In total, 5244 admissions were assessed.

Results: Of the admissions, 1459 were repeat exams, and 3785 were cases. 50.9% (n = 1927) of the cases came in SD19 and 49.1% (n = 1858) in SD20. In 2019, 37% (n = 825) of cases were girls, compared to 41.6% (n = 646) in 2020 (P = .004). The mean age of those who came in 2019 was 9.61 ± 4.08; The mean age of those who came in 2020 was 10.15 ± 5.38 (P = .002). In 2020, oppositional defiant conduct disorder, major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, sleep-wake disorder, and dysthymia were significantly higher, while specific learning disorders, separation anxiety disorder, and intellectual disability were found to be lower.

Conclusion: The decrease in second-wave admissions is less than in the first wave. In the second wave, externalizing and internalizing problems have increased. Drug therapy was prioritized. Postponing admissions was less in the second wave.

Background: Psychological resilience is defined as the resilience capacity and the power to recover in the face of stressful life events. Adolescents in institutional care have different individual, familial, and environmental risk factors that negatively affect their psychological resilience. This study aimed to comparatively examine studies that detect the risk factors affecting the resilience of adolescents living in institutional care and make recommendations regarding initiatives or specific outcomes related to this.

Methods: This study systematically reviewed national and international literature databases such as PubMed, Web of Science, Science Direct, Medline, CINAHL, EBSCO host, Psychinfo, Cochrane Library, Turkish Ulakbim, Turkish Medical Directory, and Turkish Psychiatry Directory up to December 2021. Fourteen studies were included in this study.

Results: Many significant risk factors, such as adolescents' interpersonal relationships, self-confidence, self-esteem, self-efficacy levels, problem-solving skills, empathy skills, as well as parental abandonment, domestic violence, socioeconomic poverty, a history of abuse, peer rejection, lack of social support resources, and low academic performance, have been identified and discussed at individual, familial, and environmental levels.

Conclusion: Adolescents in institutional care were more vulnerable and had more mental and behavioral problems than their peers. This systematic review found no studies evaluating preventive programs, interventions, or interventions designed to reduce the frequency and prevalence of future adverse events for children growing up in institutional care settings. Recommends the comprehensive inclusion and evaluation of preventive programs, practices, and assessments aimed at reducing the frequency and prevalence of risk factors affecting resilience.

Background: Childhood maltreatment has great impact on physical and mental health. This study was designed to investigate the relationship between childhood maltreatment experience, social support, Anxiety and Depression, and traumatic stress symptoms in adults.

Methods: There were 113 subjects aged 20-35 recruited. They filled out self-reported questionnaires, including the Childhood Trauma Questionnaire Short Form (CTQ-SF), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), International Trauma Questionnaire (ITQ), Chinese version of the PTSD Checklist for DSM-5 (PCL-5), and Multidimensional Scale of Perceived Social Support (MSPSS), to measure symptom severity regarding childhood maltreatment, Anxiety and Depression, post-traumatic stress/complex post-traumatic stress symptoms (PTSD/CPTSD), and social support. The symptom severity was compared between maltreatment and non-maltreatment groups. Regression and mediator analyzes were done to investigate the relationship between maltreatment experience, mental impact severity, and the role of social support.

Results: There were 74.3% of participants who had been maltreated as children. Those who experienced maltreatment had more PTSD/CPTSD symptom severity than those who did not. Family support, but not friend support, mediated the relationship between maltreatment and PTSD/CPTSD symptom severity.

Conclusion: Childhood maltreatment was associated with Anxiety and Depression and CPTSD symptom severity in young adults. Future prospective studies are warranted to investigate the role of family support in preventing consequences after maltreatment.