Pub Date : 2024-05-22DOI: 10.1017/S0033291724000990
André J McDonald, Paul Kurdyak, Jürgen Rehm, Michael Roerecke, Susan J Bondy
Background: Epidemiologic research suggests that youth cannabis use is associated with psychotic disorders. However, current evidence is based heavily on 20th-century data when cannabis was substantially less potent than today.
Methods: We linked population-based survey data from 2009 to 2012 with records of health services covered under universal healthcare in Ontario, Canada, up to 2018. The cohort included respondents aged 12-24 years at baseline with no prior psychotic disorder (N = 11 363). The primary outcome was days to first hospitalization, ED visit, or outpatient visit related to a psychotic disorder according to validated diagnostic codes. Due to non-proportional hazards, we estimated age-specific hazard ratios during adolescence (12-19 years) and young adulthood (20-33 years). Sensitivity analyses explored alternative model conditions including restricting the outcome to hospitalizations and ED visits to increase specificity.
Results: Compared to no cannabis use, cannabis use was significantly associated with psychotic disorders during adolescence (aHR = 11.2; 95% CI 4.6-27.3), but not during young adulthood (aHR = 1.3; 95% CI 0.6-2.6). When we restricted the outcome to hospitalizations and ED visits only, the strength of association increased markedly during adolescence (aHR = 26.7; 95% CI 7.7-92.8) but did not change meaningfully during young adulthood (aHR = 1.8; 95% CI 0.6-5.4).
Conclusions: This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. The strength of association during adolescence was notably greater than in previous studies, possibly reflecting the recent rise in cannabis potency.
背景:流行病学研究表明,青少年吸食大麻与精神障碍有关。然而,目前的证据主要基于 20 世纪的数据,当时大麻的效力远不如现在:我们将 2009 年至 2012 年的人口调查数据与加拿大安大略省截至 2018 年的全民医疗保健覆盖范围内的医疗服务记录联系起来。队列包括基线年龄为 12-24 岁、之前未患有精神病性障碍的受访者(N = 11 363)。主要结果是根据有效诊断代码得出的与精神病性障碍相关的首次住院、急诊室就诊或门诊就诊天数。由于非比例危害,我们估算了青春期(12-19 岁)和青年期(20-33 岁)的特定年龄危害比。敏感性分析探讨了其他模型条件,包括将结果限制为住院和急诊室就诊,以提高特异性:与不使用大麻相比,青春期使用大麻与精神病性障碍有显著相关性(aHR = 11.2;95% CI 4.6-27.3),但在青年期则没有显著相关性(aHR = 1.3;95% CI 0.6-2.6)。当我们将结果仅限于住院治疗和急诊室就诊时,相关性在青少年时期明显增加(aHR = 26.7; 95% CI 7.7-92.8),但在青年成年期没有明显变化(aHR = 1.8; 95% CI 0.6-5.4):这项研究提供了新的证据,证明吸食大麻与精神失常风险之间存在密切但依赖于年龄的联系,这与神经发育理论一致,即青春期是吸食大麻的脆弱时期。与以往的研究相比,青春期的关联强度明显更大,这可能反映了近期大麻药效的上升。
{"title":"Age-dependent association of cannabis use with risk of psychotic disorder.","authors":"André J McDonald, Paul Kurdyak, Jürgen Rehm, Michael Roerecke, Susan J Bondy","doi":"10.1017/S0033291724000990","DOIUrl":"https://doi.org/10.1017/S0033291724000990","url":null,"abstract":"<p><strong>Background: </strong>Epidemiologic research suggests that youth cannabis use is associated with psychotic disorders. However, current evidence is based heavily on 20th-century data when cannabis was substantially less potent than today.</p><p><strong>Methods: </strong>We linked population-based survey data from 2009 to 2012 with records of health services covered under universal healthcare in Ontario, Canada, up to 2018. The cohort included respondents aged 12-24 years at baseline with no prior psychotic disorder (<i>N</i> = 11 363). The primary outcome was days to first hospitalization, ED visit, or outpatient visit related to a psychotic disorder according to validated diagnostic codes. Due to non-proportional hazards, we estimated age-specific hazard ratios during adolescence (12-19 years) and young adulthood (20-33 years). Sensitivity analyses explored alternative model conditions including restricting the outcome to hospitalizations and ED visits to increase specificity.</p><p><strong>Results: </strong>Compared to no cannabis use, cannabis use was significantly associated with psychotic disorders during adolescence (aHR = 11.2; 95% CI 4.6-27.3), but not during young adulthood (aHR = 1.3; 95% CI 0.6-2.6). When we restricted the outcome to hospitalizations and ED visits only, the strength of association increased markedly during adolescence (aHR = 26.7; 95% CI 7.7-92.8) but did not change meaningfully during young adulthood (aHR = 1.8; 95% CI 0.6-5.4).</p><p><strong>Conclusions: </strong>This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. The strength of association during adolescence was notably greater than in previous studies, possibly reflecting the recent rise in cannabis potency.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22DOI: 10.1017/S0033291724000941
Stephanie Haering, Antonia V Seligowski, Sarah D Linnstaedt, Vasiliki Michopoulos, Stacey L House, Francesca L Beaudoin, Xinming An, Thomas C Neylan, Gari D Clifford, Laura T Germine, Scott L Rauch, John P Haran, Alan B Storrow, Christopher Lewandowski, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Robert A Swor, Nina T Gentile, Lauren A Hudak, Jose L Pascual, Mark J Seamon, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Leon D Sanchez, Steven E Bruce, Steven E Harte, Samuel A McLean, Ronald C Kessler, Karestan C Koenen, Jennifer S Stevens, Abigail Powers
Background: Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.
Methods: As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.
Results: Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.
Conclusions: Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.
{"title":"Sex-dependent differences in vulnerability to early risk factors for posttraumatic stress disorder: results from the AURORA study.","authors":"Stephanie Haering, Antonia V Seligowski, Sarah D Linnstaedt, Vasiliki Michopoulos, Stacey L House, Francesca L Beaudoin, Xinming An, Thomas C Neylan, Gari D Clifford, Laura T Germine, Scott L Rauch, John P Haran, Alan B Storrow, Christopher Lewandowski, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Robert A Swor, Nina T Gentile, Lauren A Hudak, Jose L Pascual, Mark J Seamon, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Leon D Sanchez, Steven E Bruce, Steven E Harte, Samuel A McLean, Ronald C Kessler, Karestan C Koenen, Jennifer S Stevens, Abigail Powers","doi":"10.1017/S0033291724000941","DOIUrl":"https://doi.org/10.1017/S0033291724000941","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.</p><p><strong>Methods: </strong>As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.</p><p><strong>Results: </strong>Women reported higher PTSD severity at 3-months post-trauma. <i>Z</i>-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.</p><p><strong>Conclusions: </strong>Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22DOI: 10.1017/S0033291724001181
Edita Fino
{"title":"On the importance of understanding and addressing stigmatization experiences in refugees.","authors":"Edita Fino","doi":"10.1017/S0033291724001181","DOIUrl":"https://doi.org/10.1017/S0033291724001181","url":null,"abstract":"","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22DOI: 10.1017/s0033291724000953
Maria J. E. Schouten, A. Goudriaan, Michael P. Schaub, Jack J. M. Dekker, M. Blankers
Problematic drinking frequently co-occurs with depression among young adults, but often remains unaddressed in depression treatment. Evidence is insufficient on whether digital alcohol interventions can be effective in this young comorbid population. In a randomized controlled trial, we examined the effectiveness of Beating the Booze (BtB), an add-on digital alcohol intervention to complement depression treatment for young adults. Participants were randomized to BtB + depression treatment as usual (BTB + TAU, n = 81) or TAU (n = 82). The primary outcome was treatment response, a combined measure for alcohol and depression after 6-month follow-up. Secondary outcomes were number of weekly drinks (Timeline Follow-back) and depressive symptoms (Center for Epidemiologic Studies Depression scale). Treatment response was analyzed using generalized linear modeling and secondary outcomes using robust linear mixed modeling. Low treatment response was found due to lower than expected depression remission rates. No statistically significant between-group effect was found for treatment response after 6-month follow-up (odds ratio 2.86, p = 0.089, 95% confidence interval [CI] 0.85–9.63). For our secondary outcomes, statistically significant larger reductions in weekly drinks were found in the intervention group after 3-month (B = −4.00, p = 0.009, 95% CI −6.97 to −1.02, d = 0.27) and 6-month follow-up (B = −3.20, p = 0.032, 95% CI −6.13 to −0.27, d = 0.23). We found no statistically significant between-group differences on depressive symptoms after 3-month (B = −0.57, p = 0.732, 95% CI −3.83 to 2.69) nor after 6-month follow-up (B = −0.44, p = 0.793, 95% CI −3.69 to 2.82). The add-on digital alcohol intervention was effective in reducing alcohol use, but not in reducing depressive symptoms and treatment response among young adults with co-occurring depressive disorders and problematic alcohol use. Pre-registered on October 29, 2019 in the Overview of Medical Research in the Netherlands (OMON), formerly the Dutch Trial Register(https://onderzoekmetmensen.nl/en/trial/49219).
{"title":"Effectiveness of a digital alcohol intervention as an add-on to depression treatment for young adults: results of a pragmatic randomized controlled trial","authors":"Maria J. E. Schouten, A. Goudriaan, Michael P. Schaub, Jack J. M. Dekker, M. Blankers","doi":"10.1017/s0033291724000953","DOIUrl":"https://doi.org/10.1017/s0033291724000953","url":null,"abstract":"\u0000 \u0000 \u0000 Problematic drinking frequently co-occurs with depression among young adults, but often remains unaddressed in depression treatment. Evidence is insufficient on whether digital alcohol interventions can be effective in this young comorbid population. In a randomized controlled trial, we examined the effectiveness of Beating the Booze (BtB), an add-on digital alcohol intervention to complement depression treatment for young adults.\u0000 \u0000 \u0000 \u0000 Participants were randomized to BtB + depression treatment as usual (BTB + TAU, n = 81) or TAU (n = 82). The primary outcome was treatment response, a combined measure for alcohol and depression after 6-month follow-up. Secondary outcomes were number of weekly drinks (Timeline Follow-back) and depressive symptoms (Center for Epidemiologic Studies Depression scale). Treatment response was analyzed using generalized linear modeling and secondary outcomes using robust linear mixed modeling.\u0000 \u0000 \u0000 \u0000 Low treatment response was found due to lower than expected depression remission rates. No statistically significant between-group effect was found for treatment response after 6-month follow-up (odds ratio 2.86, p = 0.089, 95% confidence interval [CI] 0.85–9.63). For our secondary outcomes, statistically significant larger reductions in weekly drinks were found in the intervention group after 3-month (B = −4.00, p = 0.009, 95% CI −6.97 to −1.02, d = 0.27) and 6-month follow-up (B = −3.20, p = 0.032, 95% CI −6.13 to −0.27, d = 0.23). We found no statistically significant between-group differences on depressive symptoms after 3-month (B = −0.57, p = 0.732, 95% CI −3.83 to 2.69) nor after 6-month follow-up (B = −0.44, p = 0.793, 95% CI −3.69 to 2.82).\u0000 \u0000 \u0000 \u0000 The add-on digital alcohol intervention was effective in reducing alcohol use, but not in reducing depressive symptoms and treatment response among young adults with co-occurring depressive disorders and problematic alcohol use.\u0000 \u0000 \u0000 \u0000 Pre-registered on October 29, 2019 in the Overview of Medical Research in the Netherlands (OMON), formerly the Dutch Trial Register(https://onderzoekmetmensen.nl/en/trial/49219).\u0000","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1017/S0033291724001041
Peter Schofield, Christopher Jamil de Montgomery, Anna Piil Damm, Esben Agerbo
Background: Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design.
Methods: We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders.
Results: Refugees assigned to neighborhoods with fewer co-nationals (lowest v. highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06-1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05-1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03-1.50). We found no statistically significant associations with proportion of migrants.
Conclusions: For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.
{"title":"Neighborhood social composition and refugee mental health - quasi-experimental evidence of associations from a Danish population register study.","authors":"Peter Schofield, Christopher Jamil de Montgomery, Anna Piil Damm, Esben Agerbo","doi":"10.1017/S0033291724001041","DOIUrl":"https://doi.org/10.1017/S0033291724001041","url":null,"abstract":"<p><strong>Background: </strong>Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design.</p><p><strong>Methods: </strong>We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders.</p><p><strong>Results: </strong>Refugees assigned to neighborhoods with fewer co-nationals (lowest <i>v.</i> highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06-1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05-1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03-1.50). We found no statistically significant associations with proportion of migrants.</p><p><strong>Conclusions: </strong>For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1017/S0033291724001144
D. Fennema, G. Barker, Owen O’Daly, S. Duan, Beata R. Godlewska, Kimberley Goldsmith, Allan H. Young, Jorge Moll, Roland Zahn
BACKGROUND Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD. METHODS Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (n = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad v. happy faces from two pre-registered a priori defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item). RESULTS We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad v. happy faces predicted favorable clinical outcomes (rs[38] = 0.40, p = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (rs[38] = 0.18, p = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected p < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels. CONCLUSIONS We confirmed the prediction that a lower amygdala response to negative v. positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.
背景杏仁核和背侧前扣带回皮层对面部情绪的反应有望预测无药物治疗的重度抑郁障碍(MDD)患者的治疗反应。方法45名对⩾2种血清素能抗抑郁药无反应的重度抑郁症患者(n = 42,符合预定义的fMRI最低质量阈值)被纳入研究,并在4个月的标准初级保健期间接受随访。在进行药物复查之前,使用潜意识面部情绪 fMRI 从两个预先注册的先验定义区域(双侧杏仁核和背侧/前扣带回皮层)提取血氧水平对悲伤与快乐面部的依赖性效应。结果我们证实了预先注册的假设 (NCT04342299),即双侧杏仁核对悲伤与快乐面孔较低的激活预示着有利的临床结果 (rs[38] = 0.40, p = 0.01)。相比之下,背侧/前额扣带回皮层激活没有影响(rs[38] = 0.18,p = 0.29),使用基于象素的全脑分析也没有影响(基于象素的家族-明智误差校正 p <0.05)。我们证实了这样的预测,即杏仁核对负面与正面面部表情的反应较低可能是一种适应性神经特征,它可以预测难以治疗的 MDD 患者随后的症状改善情况。焦虑降低了杏仁核的适应性反应。
{"title":"Neural responses to facial emotions and subsequent clinical outcomes in difficult-to-treat depression.","authors":"D. Fennema, G. Barker, Owen O’Daly, S. Duan, Beata R. Godlewska, Kimberley Goldsmith, Allan H. Young, Jorge Moll, Roland Zahn","doi":"10.1017/S0033291724001144","DOIUrl":"https://doi.org/10.1017/S0033291724001144","url":null,"abstract":"BACKGROUND\u0000Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD.\u0000\u0000\u0000METHODS\u0000Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (n = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad v. happy faces from two pre-registered a priori defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item).\u0000\u0000\u0000RESULTS\u0000We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad v. happy faces predicted favorable clinical outcomes (rs[38] = 0.40, p = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (rs[38] = 0.18, p = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected p < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels.\u0000\u0000\u0000CONCLUSIONS\u0000We confirmed the prediction that a lower amygdala response to negative v. positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140963176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1017/S0033291724001089
T. Pemovska, S. Loizou, Rebecca Appleton, D. Spain, T. Stefanidou, A. Kular, Ruth Cooper, A. Greenburgh, Jessica Griffiths, P. Barnett, U. Foye, Helen Baldwin, M. Minchin, G. Brady, K. Saunders, Nafiso Ahmed, R. Jackson, R. Olive, J. Parker, A. Timmerman, S. Sapiets, E. Driskell, B. Chipp, B. Parsons, V. Totsika, Will Mandy, R. Pender, P. Clery, B. Lloyd-Evans, Alan Simpson, Sonia Johnson
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
{"title":"Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis.","authors":"T. Pemovska, S. Loizou, Rebecca Appleton, D. Spain, T. Stefanidou, A. Kular, Ruth Cooper, A. Greenburgh, Jessica Griffiths, P. Barnett, U. Foye, Helen Baldwin, M. Minchin, G. Brady, K. Saunders, Nafiso Ahmed, R. Jackson, R. Olive, J. Parker, A. Timmerman, S. Sapiets, E. Driskell, B. Chipp, B. Parsons, V. Totsika, Will Mandy, R. Pender, P. Clery, B. Lloyd-Evans, Alan Simpson, Sonia Johnson","doi":"10.1017/S0033291724001089","DOIUrl":"https://doi.org/10.1017/S0033291724001089","url":null,"abstract":"Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1017/S0033291724001089
Tamara Pemovska, Sofia Loizou, Rebecca Appleton, Debbie Spain, Theodora Stefanidou, Ariana Kular, Ruth Cooper, Anna Greenburgh, Jessica Griffiths, Phoebe Barnett, Una Foye, Helen Baldwin, Matilda Minchin, Gráinne Brady, Katherine R K Saunders, Nafiso Ahmed, Robin Jackson, Rachel Rowan Olive, Jennie Parker, Amanda Timmerman, Suzi Sapiets, Eva Driskell, Beverley Chipp, Bethany Parsons, Vaso Totsika, Will Mandy, Richard Pender, Philippa Clery, Brynmor Lloyd-Evans, Alan Simpson, Sonia Johnson
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
{"title":"Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis.","authors":"Tamara Pemovska, Sofia Loizou, Rebecca Appleton, Debbie Spain, Theodora Stefanidou, Ariana Kular, Ruth Cooper, Anna Greenburgh, Jessica Griffiths, Phoebe Barnett, Una Foye, Helen Baldwin, Matilda Minchin, Gráinne Brady, Katherine R K Saunders, Nafiso Ahmed, Robin Jackson, Rachel Rowan Olive, Jennie Parker, Amanda Timmerman, Suzi Sapiets, Eva Driskell, Beverley Chipp, Bethany Parsons, Vaso Totsika, Will Mandy, Richard Pender, Philippa Clery, Brynmor Lloyd-Evans, Alan Simpson, Sonia Johnson","doi":"10.1017/S0033291724001089","DOIUrl":"https://doi.org/10.1017/S0033291724001089","url":null,"abstract":"<p><p>Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1017/S0033291724001144
Diede Fennema, Gareth J Barker, Owen O'Daly, Suqian Duan, Beata R Godlewska, Kimberley Goldsmith, Allan H Young, Jorge Moll, Roland Zahn
Background: Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD.
Methods: Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (n = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad v. happy faces from two pre-registered a priori defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item).
Results: We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad v. happy faces predicted favorable clinical outcomes (rs[38] = 0.40, p = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (rs[38] = 0.18, p = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected p < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels.
Conclusions: We confirmed the prediction that a lower amygdala response to negative v. positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.
{"title":"Neural responses to facial emotions and subsequent clinical outcomes in difficult-to-treat depression.","authors":"Diede Fennema, Gareth J Barker, Owen O'Daly, Suqian Duan, Beata R Godlewska, Kimberley Goldsmith, Allan H Young, Jorge Moll, Roland Zahn","doi":"10.1017/S0033291724001144","DOIUrl":"https://doi.org/10.1017/S0033291724001144","url":null,"abstract":"<p><strong>Background: </strong>Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD.</p><p><strong>Methods: </strong>Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (<i>n</i> = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad <i>v.</i> happy faces from two pre-registered <i>a priori</i> defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item).</p><p><strong>Results: </strong>We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad <i>v.</i> happy faces predicted favorable clinical outcomes (<i>r<sub>s</sub></i>[38] = 0.40, <i>p</i> = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (<i>r<sub>s</sub></i>[38] = 0.18, <i>p</i> = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected <i>p</i> < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels.</p><p><strong>Conclusions: </strong>We confirmed the prediction that a lower amygdala response to negative <i>v.</i> positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1017/S0033291724001132
Rui Xue, Xiaojing Li, Wei Deng, Chengqian Liang, Mingxia Chen, Jianning Chen, Sugai Liang, Wei Wei, Yamin Zhang, Hua Yu, Yan Xu, Wanjun Guo, Tao Li
Background: Microstates of an electroencephalogram (EEG) are canonical voltage topographies that remain quasi-stable for 90 ms, serving as the foundational elements of brain dynamics. Different changes in EEG microstates can be observed in psychiatric disorders like schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the similarities and disparatenesses in whole-brain dynamics on a subsecond timescale among individuals diagnosed with SCZ, BD, and MDD are unclear.
Methods: This study included 1112 participants (380 individuals diagnosed with SCZ, 330 with BD, 212 with MDD, and 190 demographically matched healthy controls [HCs]). We assembled resting-state EEG data and completed a microstate analysis of all participants using a cross-sectional design.
Results: Our research indicates that SCZ, BD, and MDD exhibit distinct patterns of transition among the four EEG microstate states (A, B, C, and D). The analysis of transition probabilities showed a higher frequency of switching from microstates A to B and from B to A in each patient group compared to the HC group, and less frequent transitions from microstates A to C and from C to A in the SCZ and MDD groups compared to the HC group. And the probability of the microstate switching from C to D and D to C in the SCZ group significantly increased compared to those in the patient and HC groups.
Conclusions: Our findings provide crucial insights into the abnormalities involved in distributing neural assets and enabling proper transitions between different microstates in patients with major psychiatric disorders.
背景:脑电图(EEG)的微态是典型的电压拓扑图,在 90 毫秒内保持准稳定,是大脑动态的基本要素。在精神分裂症(SCZ)、重度抑郁症(MDD)和双相情感障碍(BD)等精神疾病中,可以观察到脑电图微状态的不同变化。然而,被诊断为精神分裂症(SCZ)、重度抑郁障碍(MDD)和双相情感障碍(BD)的患者在亚秒级时间尺度上的全脑动力学异同尚不清楚:这项研究包括 1112 名参与者(380 名 SCZ 患者、330 名 BD 患者、212 名 MDD 患者和 190 名人口统计学上匹配的健康对照组 [HC])。我们收集了静息态脑电图数据,并采用横断面设计完成了对所有参与者的微状态分析:我们的研究表明,SCZ、BD 和 MDD 在四种脑电图微状态(A、B、C 和 D)之间表现出不同的转换模式。对转换概率的分析表明,与 HC 组相比,每个患者组从微状态 A 到 B 和从 B 到 A 的转换频率更高;与 HC 组相比,SCZ 和 MDD 组从微状态 A 到 C 和从 C 到 A 的转换频率更低。与患者组和 HC 组相比,SCZ 组的微状态从 C 到 D 和从 D 到 C 的转换概率明显增加:我们的研究结果为我们提供了重要的见解,有助于我们了解主要精神障碍患者神经资产分配的异常情况,以及不同微状态之间的适当转换。
{"title":"Shared and distinct electroencephalogram microstate abnormalities across schizophrenia, bipolar disorder, and depression.","authors":"Rui Xue, Xiaojing Li, Wei Deng, Chengqian Liang, Mingxia Chen, Jianning Chen, Sugai Liang, Wei Wei, Yamin Zhang, Hua Yu, Yan Xu, Wanjun Guo, Tao Li","doi":"10.1017/S0033291724001132","DOIUrl":"https://doi.org/10.1017/S0033291724001132","url":null,"abstract":"<p><strong>Background: </strong>Microstates of an electroencephalogram (EEG) are canonical voltage topographies that remain quasi-stable for 90 ms, serving as the foundational elements of brain dynamics. Different changes in EEG microstates can be observed in psychiatric disorders like schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the similarities and disparatenesses in whole-brain dynamics on a subsecond timescale among individuals diagnosed with SCZ, BD, and MDD are unclear.</p><p><strong>Methods: </strong>This study included 1112 participants (380 individuals diagnosed with SCZ, 330 with BD, 212 with MDD, and 190 demographically matched healthy controls [HCs]). We assembled resting-state EEG data and completed a microstate analysis of all participants using a cross-sectional design.</p><p><strong>Results: </strong>Our research indicates that SCZ, BD, and MDD exhibit distinct patterns of transition among the four EEG microstate states (A, B, C, and D). The analysis of transition probabilities showed a higher frequency of switching from microstates A to B and from B to A in each patient group compared to the HC group, and less frequent transitions from microstates A to C and from C to A in the SCZ and MDD groups compared to the HC group. And the probability of the microstate switching from C to D and D to C in the SCZ group significantly increased compared to those in the patient and HC groups.</p><p><strong>Conclusions: </strong>Our findings provide crucial insights into the abnormalities involved in distributing neural assets and enabling proper transitions between different microstates in patients with major psychiatric disorders.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}