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: Medical procedures, such as venipuncture, are among the most common causes of fear and pain in children. This study aimed to determine whether using a virtual reality (VR) headset during venipuncture reduces children's fear and pain.

Methods: This controlled experimental study included 70 children aged 5-12 years (VR group = 35; control group = 35). Before venipuncture, each child, their parent, and an observer completed an interview-observation form and a fear scale. Following the procedure, the same participants completed both the fear and pain scales. The Children's Fear Scale (CFS) was used to assess fear levels, while the Wong-Baker FACES Pain Rating Scale was used to evaluate pain levels. Statistical analyses were performed using SPSS v25 software.

Results: Analysis of preprocedure and postprocedure CFS scores showed a statistically significant reduction in fear in the VR group compared with the control group, as reported by the children (P < .001). Pain assessments indicated that the VR group had significantly lower pain scores than the control group in evaluations by children, parents, and observers (P < .001).

Conclusion: The findings demonstrate that VR headsets effectively reduce both fear and pain in children undergoing venipuncture. Therefore, their use should be encouraged in clinical practice to improve the patient experience during medical procedures.

Background: This meta-analysis investigates the correlation between social media addiction (SMA), fear of missing out (FOMO), and loneliness.

Methods: The study encompasses research conducted from 2013 to 2023, exploring the connection between SMA, FOMO, and loneliness. A comprehensive literature search was conducted using databases such as PubMed, Google Scholar, Web of Science, and the National Thesis Center. Keywords such as "social media addiction," "fear of missing out," and "loneliness" were employed for relevant study retrieval. A total of 312 studies were identified, and, following predefined criteria, 34 studies were selected for detailed examination from that the 16 studies, comprising 9 studies on the relationship between social media addiction (SMA) and loneliness and 7 studies on the relationship between SMA and fear of missing out (FOMO) are taken for the analysis. The Pearson correlation coefficient (r) was computed as the effect size, and a random effects model was applied for the analysis.

Results: In the meta-analysis examining the relationship between SMA and loneliness, no publication bias was identified. Despite heterogeneity among the studies, the correlation effect size was determined to be 0.347 according to the random effects model. Similarly, in the meta-analysis concerning the relationship between SMA and FOMO, no publication bias was observed. Due to heterogeneity, the correlation effect size was found to be 0.647 according to the random effects model.

Conclusion: The meta-analysis demonstrated a significant, positive, and moderate relationship between SMA and loneliness. Additionally, a significant, positive, and strong association was identified between FOMO and SMA.

Background: The aim is to investigate the independent risk factors of non-suicidal self-injury (NSSI) in adolescents with depression and to construct a risk prediction model to evaluate its predictive efficacy.

Methods: Clinical data were collected from 150 adolescents diagnosed with depression who were admitted to West China Hospital of Sichuan University between October 2022 and October 2024. The patients were categorized into 2 groups based on the presence or absence of NSSI behavior: NSSI group (n = 65) and non-NSSI group (n = 85). Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to evaluate the degree of depression and anxiety. The Adolescent Self-rated Life Events Scale (ASLEC), Family Intimacy and Adaptability Scale II (FACES II-CV), Childhood Trauma Questionnaire Short Form (CTQ-SF), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate the frequency and intensity of stressful life events, family functioning, childhood trauma, and perceived social support. Independent risk factors associated with NSSI behavior were screened by univariate and multivariate multivariable logistic regression analysis, and a Nomogram model for NSSI risk prediction was established based on these factors.

Results: Significant variations were observed between the NSSI group and the non-NSSI group regarding factors such as gender, depression scores, interpersonal stress, learning stress, closeness to family, adaptability within the family, emotional abuse, emotional neglect, physical abuse, physical neglect, as well as perceived support from both family and friends (P < .05); univariate and multivariate logistic regression analyses revealed that gender (P < .001, 95% CI:1.10~1.46), interpersonal stress (P < .001, 95% CI:1.10~1.46), academic stress (P = .004, 95% CI:1.06~1.37), and somatic abuse (P < .001, 95% CI:1.51~3.34) were independent risk factors for the presence of NSSI behaviors in adolescent depression (P < .05); patients' perceived support from family (P = .002, 95% CI:0.57-0.88) was an independent protective factor for the presence of NSSI behaviors in adolescent depression (P < .05); good fit between calibration curve and ideal curve; and the area under curve of receiver operating characteristic curve was 0.868, and when the optimal risk cut-off value reached 29.30%, the model accuracy, sensitivity, and specificity were 0.787, 0.694, and 0.908, respectively.

Conclusion: Adolescents with depression are at higher risk of NSSI behavior and have complex risk factors for its occurrence. The risk prediction model constructed in the study for the occurrence of NSSI behaviors in adolescents with depression is effective in predicting the risk and may enable effective differentiation of patients at risk.

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: Observational studies indicate an association between type 1 diabetes (T1D) and suicidal or self-harm behaviors. However, the causal relationship between the 2 remains uncertain. A 2-sample bidirectional Mendelian randomization (MR) analysis to investigate the association between T1D and suicide or self-harm behavior.

Methods: All data were publicly available genome-wide association study summary statistics, and all individuals were of European descent. The inverse variance weighted (IVW) method, MR-Egger regression, and weighted median were employed to investigate the association between T1D and suicide or self-harm behavior. Sensitivity analyses were conducted using Cochran's Q test, MR-Egger regression, the MR pleiotropy residual sum method, leave-one-out analysis, and the MR residual sum and outlier test to assess the robustness of the findings.

Results: The IVW method indicated an association between T1D and suicidal or self-harm behavior (odds ratio (OR) = 1.011, 95% CI = 1.004-1.018, P = .002). However, there was no observed genetic influence on the relationship between suicidal or self-harm behavior and T1D.

Conclusion: This study, based on bidirectional 2-sample MR analysis of genetic data, validated that T1D is a risk factor for suicidal or self-harm behaviors. These findings are based on data from European-descent individuals, and their generalizability to other populations is unknown.

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: Parkinson's disease (PD), a neurodegenerative disorder, is increasingly being linked to various comorbid conditions, including mental health disorders. This study aims to evaluate the potential causal associations between genetically predicted mental health disorders and the likelihood of developing PD.

Methods: A bidirectional Mendelian randomization (MR) approach was applied using genetic variants identified from large-scale genome-wide association study as instrumental variables. Multiple MR methodologies, including inverse variance weighted, MR-Egger, and weighted median analyses, were employed to mitigate potential biases such as pleiotropy and provide robust evidence of causal relationships between mental health conditions and PD.

Results: The MR analysis revealed a significant causal link between personality disorders and PD (OR = 1.9901, 95% CI: 1.105-3.5842, P = .0219), suggesting that personality disorders may contribute to the development of PD. However, no significant causal associations were found between PD and other mental health conditions, such as obsessive-compulsive disorder, attention deficit hyperactivity disorder, bipolar disorder, depression, and schizophrenia (P > .05 for all).

Conclusion: This study suggests that personality disorders may be involved in the pathogenesis of PD, offering novel insights into the potential impact of mental health on neurodegenerative diseases. These findings lay the foundation for further exploration of the biological mechanisms linking mental health conditions and PD, with potential implications for both psychiatric and neurodegenerative disease management.

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.