Psychological Medicine最新文献

Individuals at clinical high risk (CHR) for psychosis exhibit both baseline and progressive brain structural abnormalities. However, the extent to which these changes reflect neurobiological trajectories of illness progression versus iatrogenic effects of antipsychotic (AP) treatment remains unresolved. A total of 148 AP-naïve CHRs and 65 healthy controls (HCs) underwent baseline structural magnetic resonance imaging (MRI) scans. One hundred thirty CHRs received second-generation AP treatment and completed 2-month follow-up scans. HCs also completed the follow-up scans. We compared baseline and longitudinal brain volume changes between CHRs and HCs and explored the relationship between AP treatment and brain structural changes in CHR. At baseline, CHRs showed enlarged third and inferior lateral ventricles compared to HCs. Within CHRs, larger ventricular, as well as smaller hippocampus and amygdala volumes, were associated with more severe symptoms and poorer functioning. No cortical volume differences were observed between groups at baseline, nor were cortical volumes related to clinical symptoms. After 2-month AP treatment, CHRs exhibited continued ventricular enlargement, reduced accumbens volume, and widespread cortical volume loss relative to HCs. Notably, cortical volume reductions were dose-dependent, with higher AP dose correlating with more pronounced cortical reductions. Additionally, cortical volume changes were linked to treatment response, with high-dose responders showing more significant HC-referenced changes compared to high-dose non-responders, low-dose responders, and low-dose non-responders. Our findings underscore the complex, region-specific, and clinically relevant neuroanatomical changes in CHR individuals, emphasizing the critical need to account for AP exposure in CHR neuroimaging studies.

Background: The impact of combat injury on the development of chronic pain and mental health concerns in combat-exposed populations is unknown. This study examined associations of combat injury and injury-related pain with pain-related factors and mental health outcomes, and potential mediation of the relation between combat injury and mental health outcomes by pain-related factors.

Methods: Pain interference, pain catastrophizing, pain intensity, post-traumatic stress disorder (PTSD), and major depressive episode (MDE) were assessed in (1) a probability sample of US Army soldiers and veterans cross-sectionally and (2) US Army soldiers before and 1, 3, and 9 months after deployment to Afghanistan. Associations among these variables were modeled using logistic regression and multiple mediation analyses.

Results: Among 5003 service members with cross-sectional data, combat injury-related pain was associated with increased odds of clinically significant pain intensity (OR=2.69), pain interference (OR=3.69), MDE (OR=2.17), and PTSD (OR=3.96) relative to pain from other injuries and conditions. Among 4645 service members assessed pre- and post-deployment, combat injury was associated with increased odds of new-onset pain interference (OR=2.78), pain catastrophizing (OR=2.75), PTSD (OR=4.06), and MDE (OR=2.56) 3 months post-deployment, and PTSD (OR=2.86) and MDE (OR=1.74) 9 months post-deployment. Pain-related factors mediated the relations of combat injury with post-deployment PTSD and MDE.

Conclusions: Combat injury is associated with greater odds of pain interference, pain catastrophizing, PTSD, and MDE compared to other sources of pain in a cohort of US service members. Efforts to address pain-related factors following combat injury may mitigate the risk of subsequent chronic pain and mental health disorders.

Background: Romantic relationships are important contexts for substance use and emotional well-being. We tested the hypotheses that (i) genetic predispositions for alcohol consumption would be positively associated with partner substance use, (ii) partner substance use would moderate genetic influences on one's own alcohol outcomes, and (iii) partner discordance in substance use would be associated with lower emotional well-being and relationship quality.

Methods: Analyses included 2,357 participants (M_age = 51.4, 58.2% female) from the Collaborative Studies on the Genetics of Alcoholism. Focal measures included participants' reports of their own and their current partner's past-year substance use (frequencies of alcohol use, heavy drinking, drunkenness, cannabis use, and nicotine use), emotional well-being, and relationship quality. Participants' genetic predispositions were indexed with genome-wide polygenic scores for alcohol consumption (PGS_Alc). Participant-partner substance use discordance was calculated as the difference between the participant's and their partner's use for each substance use measure, separately.

Results: Participant PGS_Alc was not significantly associated with partners' perceived substance use. Frequent perceived partner alcohol use and heavy drinking significantly amplified the association between PGS_Alc and alcohol use or drunkenness. Frequent perceived partner drunkenness and cannabis use significantly attenuated the association between PGS_Alc and heavy drinking or frequency of alcohol use. Participant-partner discordance for several substance use measures was significantly associated with lower emotional well-being and relationship quality, controlling for participant and partner substance use main effects.

Conclusions: The results highlight the importance of partner substance use in etiological models of alcohol use, emotional health outcomes, and relationship quality.

Background: Empathy involves communicating and understanding others' emotion in multisensory contexts, including visual and auditory modalities. Schizophrenia (SCZ) patients have impaired empathy, but whether the impact of visual/auditory context would be altered in SCZ patients and people with high social anhedonia (HSoA) remained unclear.

Methods: We administered the modified Chinese version of the Empathic Accuracy Task (EAT) to clinical (50 SCZ patients and 50 healthy controls) and subclinical samples (59 HSoA and 60 low social anhedonia [LSoA] participants). The EAT employed audio-only, audiovisual, and audioavatar visual conditions to assess the impact of multimodal information on empathy during positive and negative emotional events.

Results: In positive-valenced context, SCZ patients performed worse than controls in cognitive and affective empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in both audiovisual and audioavatar visual conditions, but comparable to controls in audio-only condition. In negative-valenced context, SCZ patients performed worse than controls in cognitive empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in audio-only and audiovisual conditions. Moreover, HSoA participants exhibited lower cognitive empathy than controls in positive-valenced context; and lower cognitive empathy and empathic motivation in negative-valenced context. No significant Modality-by-Group interaction was found in the HSoA-LSoA sample.

Conclusions: SCZ patients have generalized impairments of cognitive and affective empathy across positive and negative contexts, particularly in multimodal conditions. HSoA individuals are primarily impaired in cognitive empathy and empathic motivation.

Background: Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety.

Methods: Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery.

Results: The ebCBT + ACT group showed significant improvements in State-Trait Anxiety Inventory-Trait scores at 12 months (AMD = -5.30, 95% CI = -8.71 to -1.90, p = 0.002, d = -0.64) and 18 months (AMD = -7.22, 95% CI = -12.1 to -2.34, p = 0.004, d = -0.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = -3.70, 95% CI = -7.44 to 0.04, p = 0.052, d = -0.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes.

Conclusions: Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.

Background: The rising global prevalence of pediatric mental health problems requires the identification of preventable factors underlying their development. This study assessed whether maternal adverse childhood experiences (ACEs) and pregnancy stress were intergenerationally associated with offspring mental health.

Methods: This study used data from 34 sites in the nationwide Environmental Influences on Child Health Outcomes Cohort. Eligible parent-child dyads (child age: 1.5-18 years) provided data on at least one measure of maternal stress and at least one measure of child mental health. Study aims were evaluated using regression analyses, including interaction tests to determine potential effect modifiers.

Results: Participants were organized into three subsamples with data on (1) maternal ACEs (N = 2,906), (2) perceived prenatal stress (N = 4,441), and (3) both stress exposures (N = 834). After adjusting for confounders, maternal ACEs and prenatal stress were significantly associated with child mental health problems (B = 2.53 [95% confidence interval [CI]: 2.09, 2.96], p < 0.0001 and B = 2.36 [95% CI: 2.03, 2.68], p < 0.0001, respectively). Among participants with data on both stress exposures, maternal ACEs (B = 1.72, 95% CI: [0.96, 2.48], p < 0.0001) and prenatal stress (B = 2.05, 95% CI: [1.29, 2.80], p < 0.0001) were independently associated with child mental health problems. Neither maternal ACEs nor child sex modified the association between prenatal stress and child mental health problems.

Conclusions: Maternal exposure to ACEs and pregnancy stress were associated with the development of child mental health problems. These findings highlight the need for policies and interventions that mitigate exposure to adversity and protect pregnant individuals and their children from the intergenerational transmission of mental health problems.

Access to evidence-based psychosocial interventions for adults with attention-deficit/hyperactivity disorder (ADHD) remains limited, despite strong patient demand for nonpharmacological options such as cognitive behavioral therapy (CBT). Digital interventions may offer a scalable, low-threshold solution to meet this need and complement existing care. This pragmatic randomized controlled trial evaluated the effectiveness of attexis, a fully self-guided digital intervention based on CBT and mindfulness principles, as an adjunct to treatment as usual (TAU). A total of 337 adults with confirmed ADHD were randomized to either attexis + TAU or TAU alone. The primary outcome was ADHD symptom severity (Adult ADHD Self-Report Scale total score) at 3 months post-randomization (T1). Secondary outcomes included functional impairment, depressive symptoms, self-esteem, and health-related quality of life. Follow-up was conducted at 6 months (T2). Intent-to-treat analyses showed significantly lower ADHD symptom severity in the intervention group at T1 (baseline-adjusted mean difference = -5.0 points; d = 0.85, p < .001). Significant improvements were also observed across all secondary outcomes, and effects remained stable at T2. Responder analyses confirmed the clinical relevance of the findings. Subgroup analyses demonstrated consistent effects across sex, medication use, psychotherapy status, and treatment changes. No adverse events related to attexis were reported. attexis was effective in reducing ADHD symptoms and improving a broad range of functional and psychosocial outcomes. As a safe, low-threshold, fully self-guided intervention, it may serve as a valuable adjunct to routine care and help address existing gaps in access to psychosocial treatment for adults with ADHD.

Background: Subthreshold depression (StD) is considered a prodromal stage of major depressive disorder (MDD). This study aims to investigate the neurobiological mechanisms of StD by analyzing functional connectivity (FC) and cognitive function in comparison to MDD.

Methods: A total of 153 StD individuals, 188 MDD patients, and 110 healthy controls (HCs) were studied using resting-state functional magnetic resonance imaging (fMRI). Whole-brain FC was calculated using seeds from the default mode network (DMN), salience network (SN), executive control network, and affective network (AN). Cognitive function was assessed across seven domains.

Results: StD showed only a deficit in social cognition, while MDD exhibited multidomain cognitive impairments compared to HCs. Both MDD and StD exhibited reduced FC between the right anterior insula (AI) and the left inferior frontal gyrus (IFG), and increased FC between the right subcallosal cingulate cortex and the left posterior cingulate cortex (PCC), key areas of the SN and AN, compared to HCs. MDD particularly showed decreased connectivity between the left PCC and the left middle temporal gyrus, and within the left PCC, while no abnormal FC of the DMN was found in StD. Altered AI-IFG FC was positively correlated with social cognition in StD.

Conclusions: Abnormal connectivity patterns of the SN and AN may contribute to the development of depressive symptoms in StD and MDD, while altered FC of the DMN may be involved in the onset of the disease. A social cognition deficit appeared first in StD, relating to the abnormal connectivity of the SN.