Psychological Medicine最新文献

Background: Psychomotor disturbance has long been observed in major depressive disorder (MDD) and is thought to be a key indicator of illness course. However, dominant methods of measuring psychomotor disturbance, via self-report and clinician ratings, often lack objectivity and may be less sensitive to subtle psychomotor disturbances. Furthermore, the neural mechanisms of psychomotor disturbance in MDD remain unclear.

Methods: To address these gaps, we measured psychomotor agitation via a force variability paradigm and collected resting fMRI in 47 individuals with current MDD (cMDD) and 93 individuals with remitted MDD (rMDD). We then characterized whether resting-state cortico-cortical and cortico-subcortical connectivity related to force variability and depressive symptoms.

Results: Behaviorally, individuals with cMDD exhibited greater force variability than rMDD individuals (t(138) = 3.01, p = 0.003, Cohen's d = 0.25). Furthermore, greater force variability was associated with less visuomotor connectivity (r(130) = -0.23, p = 0.009, 95% CI [-0.38, -0.06]). Visuomotor connectivity was significantly reduced in cMDD relative to rMDD (t(130) = -2.77, p = 0.006, Cohen's d = -0.24) and mediated the group difference in force variability (ACME β = -0.06, 95% CI [-0.16, -0.01], p = 0.04).

Conclusions: Our findings represent a crucial step toward clarifying the pathophysiology of psychomotor agitation in MDD. Specifically, altered visuomotor functional connectivity emerged as a candidate neural mechanism, highlighting a promising direction for future research on dysfunctional visually guided movements in MDD.

Background: Severe mental disorders (SMDs) impose profound suffering on patients and heavy burdens on family caregivers, often resulting in abusive behaviors. This study aimed to examine the association between psychiatric symptom severity and caregiver abuse, and to assess whether caregiver tobacco dependence moderates this relationship.

Methods: A cross-sectional study included 763 patient-caregiver dyads in rural Shandong, China. Psychiatric symptom severity was measured using the 18-item Brief Psychiatric Rating Scale. Caregiver tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence. Patients reported caregivers' verbal/physical abuse in the past year. Ordered logistic regression and interaction terms tested associations and moderation.

Results: Overall, 25.7% of caregivers engaged in verbal abuse and 14.9% in physical abuse. Psychiatric symptom severity was significantly associated with both verbal (OR = 1.018, 95% CI: 1.010-1.026) and physical abuse (OR = 1.015, 95% CI: 1.005-1.025). Caregivers with moderate to severe tobacco dependence were more likely to commit verbal (OR = 1.851, 95% CI: 1.136-3.016) and physical abuse (OR = 2.292, 95% CI: 1.287-4.079) than non-smokers. Moderate to severe tobacco dependence significantly amplified the association between psychiatric symptom severity and verbal abuse (interaction OR = 1.024, 95% CI: 1.002-1.046), but not physical abuse.

Conclusion: In rural China, greater psychiatric symptom severity among patients with SMDs is associated with increased frequency of both verbal and physical abuse by caregivers, particularly verbal abuse among those with moderate to severe tobacco dependence, underscoring the need for caregiver-targeted psychological support and tobacco cessation interventions.

Background: Alterations in the central and peripheral energy metabolism are increasingly recognized as key pathophysiological processes in psychiatric disorders. We investigated mitochondrial respiration and density linked to cellular energy metabolism and oxidative DNA damage in borderline personality disorder (BPD).

Methods: This cross-sectional case-control study compared three groups matched for age and body mass index: women with acute BPD, remitted BPD, and female healthy controls (n = 32, 15, 29). Peripheral blood mononuclear cells were investigated for differences in mitochondrial respiration, density, and markers of oxidative DNA damage.

Results: Participants with acute BPD showed significantly reduced and less efficient mitochondrial ATP production compared to both remitted individuals and controls. Mitochondrial coupling and respiration were inversely associated with oxidative DNA damage, although DNA damage levels did not differ significantly across diagnostic groups. Sensitivity analyses indicated that comorbid major depressive episodes and antidepressant use did not account for the results.

Conclusions: These findings indicate mitochondrial alterations accompany acute symptom severity in BPD and may improve with remission. Unraveling causes and consequences of mitochondrial downregulation and its interplay with DNA maintenance in the context of stress and psychopathology could contribute to novel models and treatment strategies in BPD and related severe psychiatric disorders.

Background: Insight into psychosis is a multidimensional construct involving awareness of illness, attribution of symptoms, and perceived need for treatment. Despite extensive research, substantial variability in how insight is conceptualized and measured continues to hinder clinical assessment and cross-study comparisons.

Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and a registered International Prospective Register of Systematic Reviews protocol (CRD42024558386), we conducted a systematic search across five databases (n = 2,184). Twenty-nine studies met the inclusion criteria, comprising 15 primary scale development papers and 10 independent validation studies. We included instruments explicitly designed to assess insight in schizophrenia-spectrum, and evaluated them using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Psychometric domains assessed included content validity, structural validity, construct validity, criterion validity, internal consistency, reliability, responsiveness, and interpretability.

Results: Fifteen distinct insight scales were identified, comprising nine clinician-rated instruments, five self-report tools, and one hybrid format. Most demonstrated adequate content and structural validity, with 11 achieving 'very good' reliability ratings. Four scales showed the strongest overall psychometric support. However, responsiveness to clinical change was rarely tested, and cross-cultural validation remained limited. Earlier instruments primarily emphasized clinician-rated illness awareness, whereas more recent tools incorporated cognitive, neurocognitive, and subjective dimensions. Discrepancies between self-report and clinician ratings were common and often clinically meaningful. These findings underscore the need for multidimensional, psychometrically robust, and context-sensitive tools to advance both clinical assessment and research on insight in psychotic disorders.

Background: Social interaction is a primary aspect of communicating how others judge us. It allows us to update ourselves and our expectations about others. While humans generally exhibit self-related positive biases in their updating behavior, theoretical accounts propose that this biased processing is attenuated, absent, or negatively biased in participants with depressive symptoms. The process of aligning and integrating social evaluative feedback in realistic interaction scenarios that would test this assumption is, however, lacking. We provide an event-related potential (ERP) study that combines neuronal (feedback-related negativity [FRN] and late positive potential [LPP]) and behavioral measures of evaluative feedback processing and updating behavior.

Methods: We selected healthy adults (N = 62) with depression scores spanning a range of low to high values, as measured by the Beck Depression Inventory (BDI). Participants received feedback from supposed experts and peer senders, with the feedback being manipulated to be worse, congruent, or better than the participants' self-ratings.

Results: Participants with higher depression scores exhibited more negative initial self-ratings and developed a more negative feedback expectation across the experiment. In addition, we found that higher depression scores led to more negative updating toward worse expert feedback and less positive updating after better peer feedback. Concerning ERPs, unexpected but not self-incongruent feedback increased the FRN, while both types of incongruence increased the LPP. Finally, BDI scores correlated with LPP amplitudes for all feedback.

Conclusions: The results contribute to a deeper understanding of how individuals process and integrate social evaluative feedback and its relation to depressive symptoms.

Background: Ecological momentary assessment (EMA) is increasingly recognized as a vital tool for tracking the fluctuating nature of mental states and symptoms in psychiatric research. However, determining the optimal sampling rate - that is, deciding how often participants should be queried to report their symptoms - remains a significant challenge. To address this issue, our study utilizes the Nyquist-Shannon theorem from signal processing, which establishes that any sampling rate more than twice the highest frequency component of a signal is adequate.

Methods: We applied the Nyquist-Shannon theorem to analyze two EMA datasets on depressive symptoms, encompassing a combined total of 35,452 data points collected over periods ranging from 30 to 90 days per individual.

Results: Our analysis of both datasets suggests that the most effective sampling strategy involves measurements at least every other week. We find that measurements at higher frequencies provide valuable and consistent information across both datasets, with significant peaks at weekly and daily intervals.

Conclusions: Ideal frequency for measurements remains largely consistent, regardless of the specific symptoms used to estimate depression severity. For conditions in which abrupt or transient symptom dynamics are expected, such as during treatment, more frequent data collection is recommended. However, for regular monitoring, weekly assessments of depressive symptoms may be sufficient. We discuss the implications of our findings for EMA study optimization, address our study's limitations, and outline directions for future research.

Background: Shared genetic risk has been shown across psychiatric disorders. In particular, anorexia nervosa (AN), obsessive-compulsive disorder (OCD), and schizophrenia (SCZ) show shared genetic risk that matches clinical evidence of shared illness and cognitive phenotypes. Given this evidence, we leveraged a large US-based population-based study to determine genetic associations of disorder-specific and shared psychiatric, cognitive, and brain markers and explore whether the latter might be state versus trait markers in eating disorders.

Methods: We used data from the population-based Philadelphia Neurodevelopmental Cohort (N = 4,729) and conducted sex-stratified analyses to test for associations between genetic risk for three disorders (AN, OCD, and SCZ) and mental health phenotypes, neurocognitive traits, and cortical features in a non-clinical population. Exploratory analyses on cortical features were run on a subset with neuroimaging data (N = 626).

Results: Genetic risk for AN was significantly associated with body image distortion (p_FDR = 0.02), and body image distortion was significantly related to a reduction in grey matter volume (p_FDR = 0.05).

Conclusion: Genetic risk for AN associates with AN trait in a non-clinical sample of youth, particularly in females. Whilst genetic risk was not associated with cognitive or cortical markers, the AN phenotype was associated with cortical markers.

Background: As populations age rapidly, understanding the psychological benefits of sustained employment has become increasingly important. In South Korea, where the suicide rate among older adults is one of the highest among Organisation for Economic Co-operation and Development (OECD) countries, identifying modifiable social determinants, such as employment, may inform effective prevention strategies.

Methods: This retrospective cohort study used data from the Korean Welfare Panel Study (2009-2024), a nationally representative longitudinal survey. Individuals with depressive symptoms or suicidal ideation at baseline were excluded. The main exposure was participation in a government-led senior employment program. We employed discrete-time survival analysis using a generalized linear model with a complementary log-log link function, which appropriately handled the interval-censored structure of the panel data.

Results: Older adults who participated in the employment program had a significantly lower risk of developing depressive symptoms (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI]: 0.67-0.86) and suicidal ideation (adjusted HR = 0.60, 95% CI: 0.45-0.81) compared to those who did not participate. Subgroup analyses revealed that the strength of the association was particularly strong among individuals aged ≥80 years, those with chronic illness, poor self-rated health, and those who were previously or never married.

Conclusion: Structured government-supported employment may mitigate the risk of depressive symptoms and suicidal ideation in later life. These findings support the potential of senior employment programs as effective mental health promotion and suicide prevention strategies for aging populations.

Background: Recovery rates for panic disorder in NHS Talking Therapies (NHSTT) services in the United Kingdom do not match those in randomized trials. Previous research has found that training therapists in 'focused cognitive behavioral therapy' (CBT) improves outcomes. The primary aim was to examine whether focused CBT delivered by trained psychological well-being practitioners (PWPs) can improve treatment outcomes for panic disorder. An exploratory aim was to evaluate the potential impact of a novel component of focused CBT, which includes the use of 'approach-supporting behaviors' (ASBs) where safety-seeking behaviors (SSBs) are prominent.

Methods: We conducted a randomized parallel trial. Participants were randomly allocated to focused CBT or the current treatment at 'Step Two' (treatment as usual) in two NHSTT services (ISRCTN:11268881).

Results: We found a significant group-timepoint interaction. Those in focused CBT had significantly greater reductions in the primary measure of panic severity relative to those in treatment as usual (TAU). The level of ASBs did not predict a change in panic severity; however, the level of SSBs at the end of treatment did predict a change in panic severity.

Conclusions: Focused CBT is effective for panic disorder and is superior to TAU, supporting the applicability of this lower-intensity and panic-specific version of CBT for panic disorder.

Schizophrenia features pervasive insight deficits, with many failing to recognize symptoms or the need for treatment, predictors of poorer outcomes. Rather than unitary, insight comprises clinical (awareness of illness and need for care) and cognitive (self-reflectiveness and the ability to question one's beliefs). This review examines whether mental time travel (MTT) - vivid recollection of past events and construction of detailed future scenarios - may underlie insight deficits in schizophrenia. We synthesize evidence up to May 2025 from meta-analyses, experimental studies, and neuroimaging/neuroanatomical reports on MTT (autobiographical memory specificity, future simulation, temporal horizon) and their associations with clinical and cognitive insight. Individuals with schizophrenia show reduced autobiographical specificity, future simulation vividness, alongside a narrowed temporal horizon. These impairments are linked to diminished self-reflection, narrative coherence, and metacognitive abilities, all of which are essential for accurate illness recognition. Neuroimaging indicates that the networks supporting mental time travel, self-reflection, and insight - particularly the default-mode and ventromedial prefrontal circuits - substantially overlap and are disrupted in schizophrenia, with heterogeneity across illness stage and analytic approach. Moderators such as negative symptoms and trauma appear to intensify the MTT-insight links, while depressive mood may paradoxically enhance illness awareness. Although therapies targeting episodic specificity and metacognitive mastery show promise, longitudinal and interventional evidence remains limited. Associations between MTT impairments and insight are robust but largely correlational, so reverse or bidirectional causality cannot be excluded. We outline priorities for longitudinal, interventional, and trauma-stratified studies - attentive to illness stage and default-mode dynamics - to clarify mechanisms and guide targeted interventions.