Psychological Medicine最新文献

Background: Previous studies identified clusters of first-episode psychosis (FEP) patients based on cognition and premorbid adjustment. This study examined a range of socio-environmental risk factors associated with clusters of FEP, aiming a) to compare clusters of FEP and community controls using the Maudsley Environmental Risk Score for psychosis (ERS), a weighted sum of the following risks: paternal age, childhood adversities, cannabis use, and ethnic minority membership; b) to explore the putative differences in specific environmental risk factors in distinguishing within patient clusters and from controls.

Methods: A univariable general linear model (GLS) compared the ERS between 1,263 community controls and clusters derived from 802 FEP patients, namely, low (n = 223) and high-cognitive-functioning (n = 205), intermediate (n = 224) and deteriorating (n = 150), from the EU-GEI study. A multivariable GLS compared clusters and controls by different exposures included in the ERS.

Results: The ERS was higher in all clusters compared to controls, mostly in the deteriorating (β=2.8, 95% CI 2.3 3.4_, η² = 0.049) and the low-cognitive-functioning cluster (β=2.4, 95% CI 1.9 2.8, η² = 0.049) and distinguished them from the cluster with high-cognitive-functioning. The deteriorating cluster had higher cannabis exposure (mean_difference = 0.48, 95% CI 0.49 0.91) than the intermediate having identical IQ, and more people from an ethnic minority (mean_difference = 0.77, 95% CI 0.24 1.29) compared to the high-cognitive-functioning cluster.

Conclusions: High exposure to environmental risk factors might result in cognitive impairment and lower-than-expected functioning in individuals at the onset of psychosis. Some patients' trajectories involved risk factors that could be modified by tailored interventions.

Background: Individuals with borderline intellectual functioning and intellectual disabilities (intellectual impairment) may be at increased risk of psychosis. However, studies have been limited by small and selected samples. Moreover, the role of early life trauma, a key risk factor for psychosis, in the associations is unknown.

Methods: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, we investigated the associations between intellectual impairment, psychotic disorders, and psychotic experiences, and assessed the mediating role of trauma in childhood. Individuals with intellectual impairment were identified using a multisource measure utilizing indicators from ALSPAC combined with health and administrative records. Psychotic disorder diagnoses were extracted through linkage to primary care records. Psychotic experiences were assessed at ages 18 and 24 using the semi-structured Psychosis-Like Symptoms interview (PLIKSi). Trauma between ages 5 and 11 was assessed with questionnaires and interviews administered to children and parents at multiple ages. Multiple imputation was performed to mitigate bias due to missing data.

Results: The maximum sample after multiple imputation was 9,407. We found associations between intellectual impairment and psychotic disorders (OR = 4.57; 95%CI: 1.56-13.39). Evidence was weaker in the case of psychotic experiences (OR = 1.63; 95%CI: 0.93-2.84). There was some evidence suggesting a mediating role of trauma in the associations between intellectual impairment and psychotic experiences (OR = 1.09; 95%CI: 1.03-1.15). Complete records analyses yielded comparable estimates.

Conclusions: Intellectual impairment is associated with psychotic disorders and experiences in adulthood. Research into the contribution of trauma could shape intervention strategies for psychotic disorders in this population.

Background: Little is known about the dose and pattern of moderate-to-vigorous physical activity (MVPA) to prevent depression. We aimed to assess the prospective association of dose and pattern of accelerometer-derived MVPA with the risk of diagnosed depression.

Methods: We included 74,715 adults aged 40-69 years from the UK Biobank cohort who were free of severe disease at baseline and participated in accelerometer measurements (mean age 55.2 years [SD 7.8]; 58% women). MVPA at baseline was derived through 1-week wrist-worn accelerometry. Diagnosed depression was defined by hospitalization with ICD-10 codes F32.0-F32.A. Restricted cubic splines and Cox regression determined the prospective association of dose and pattern of MVPA with the risk of incident depression.

Results: Over a median 7.9-year follow-up, there were 3,089 (4.1%) incident cases of depression. Higher doses of MVPA were curvilinearly associated with lower depression risk, with the largest minute-per-minute added benefits occurring between 5 (HR 0.99 [95% CI 0.96-0.99]) and 280 (HR 0.67 [95% CI 0.60-0.74]) minutes per week (reference: 0 MVPA minutes).

Conclusion: Regardless of pattern, higher doses of MVPA were associated with lower depression risk in a curvilinear manner, with the greatest incremental benefit per minute occurring during the first 4-5 h per week. Optimal benefits occurred around 15 h/week.

Background: Early pubertal timing is associated with depressive symptoms in girls, but studies in boys are limited and have yielded conflicting results.

Methods: N = 4,664 male participants from a UK birth cohort (Avon Longitudinal Study of Parents and Children - ALSPAC). Seven indicators of pubertal timing were measured repeatedly from 7 to 17 years (age at: peak height velocity, peak weight velocity, peak bone mineral content velocity, Tanner stage 3 pubic hair, Tanner stage 3 genitalia, axillary hair, and voice break), categorised into 'early', 'on-time,' and 'late' (mean ± 1 SD). Depressive symptoms (binary variable indicating higher versus lower levels) were assessed at 14 and 18 years, and depression (ICD-10 diagnosis) was assessed at 18 years. Multivariable logistic regression was used to examine associations between each indicator of pubertal timing and depressive symptoms/depression, adjusted for socioeconomic status (SES) and prepubertal body mass index (BMI).

Results: Compared to males with normative pubertal development, the odds of depression at age 18 were higher in those with early age at peak height velocity (OR: 2.06; 95% CI 1.27-3.34), early age at peak weight velocity (OR: 2.10; 95% CI 1.16-3.79), and early age at Tanner genitalia stage 3 (OR: 1.81; 95% CI 1.01-3.26). There was no evidence for associations between pubertal timing and depressive symptoms at age 14 or 18.

Conclusions: We found evidence that males with an earlier pubertal timing had increased odds of depression at age 18. Early maturing boys could be targeted for interventions aimed at preventing depression.

Background: Late-life depression (LLD) is characterized by medial temporal lobe (MTL) abnormalities. Although gray matter (GM) and white matter (WM) differences in LLD have been reported, few studies have investigated them concurrently. Moreover, the impact of aetiological factors, such as neurodegenerative and cerebrovascular burden, on tissue differences remains elusive.

Methods: This prospective cross-sectional study involved 72 participants, including 33 patients with LLD (mean age 72.2 years, 23 female) and 39 healthy controls (HCs) (mean age 70.6 years, 24 female), who underwent clinical and positron emission tomography (PET)-magnetic resonance imaging (MRI) assessments. High-resolution 3D T1-weighted and T2-weighted FLAIR images were used to assess MTL GM volumes and white matter hyperintensities (WMHs), a proxy for cerebrovascular burden. Diffusion kurtosis imaging metrics derived from multishell diffusion MRI data were analyzed to assess WM microstructure in the following MTL bundles reconstructed using constrained spherical deconvolution tractography: uncinate fasciculus, fornix, and cingulum. Standardized uptake value ratio of 18F-MK-6240 in the MTL was used to assess Alzheimer's disease (AD) type tau accumulation as a proxy for neurodegenerative burden.

Results: Compared to HCs, patients with LLD showed significantly lower bilateral MTL volumes and WM microstructural differences primarily in the uncinate fasciculi bilaterally and right fornix. In patients with LLD, higher vascular burden, but not tau, was associated with lower MTL volume and more pronounced WM differences.

Conclusions: LLD was associated with both GM and WM differences in the MTL. Cerebrovascular disease, rather than AD type tau-mediated neurodegenerative processes, may contribute to brain tissue differences in LLD.

Background: Negative symptoms are a key feature of several psychiatric disorders. Difficulty identifying common neurobiological mechanisms that cut across diagnostic boundaries might result from equifinality (i.e., multiple mechanistic pathways to the same clinical profile), both within and across disorders. This study used a data-driven approach to identify unique subgroups of participants with distinct reward processing profiles to determine which profiles predicted negative symptoms.

Methods: Participants were a transdiagnostic sample of youth from a multisite study of psychosis risk, including 110 individuals at clinical high-risk for psychosis (CHR; meeting psychosis-risk syndrome criteria), 88 help-seeking participants who failed to meet CHR criteria and/or who presented with other psychiatric diagnoses, and a reference group of 66 healthy controls. Participants completed clinical interviews and behavioral tasks assessing four reward processing constructs indexed by the RDoC Positive Valence Systems: hedonic reactivity, reinforcement learning, value representation, and effort-cost computation.

Results: k-means cluster analysis of clinical participants identified three subgroups with distinct reward processing profiles, primarily characterized by: a value representation deficit (54%), a generalized reward processing deficit (17%), and a hedonic reactivity deficit (29%). Clusters did not differ in rates of clinical group membership or psychiatric diagnoses. Elevated negative symptoms were only present in the generalized deficit cluster, which also displayed greater functional impairment and higher psychosis conversion probability scores.

Conclusions: Contrary to the equifinality hypothesis, results suggested one global reward processing deficit pathway to negative symptoms independent of diagnostic classification. Assessment of reward processing profiles may have utility for individualized clinical prediction and treatment.

Background: Relatively little is known about mental healthcare-related harm, with patient safety incidents (PSIs) in community-based services particularly poorly understood. We aimed to characterize PSIs, contributory factors, and reporter-identified solutions within community-based mental health services for working-age adults.

Methods: We obtained data on PSIs reported within English services from the National Reporting and Learning System. Of retrieved reports, we sampled all incidents reportedly involving 'Death', 'Severe harm', or 'Moderate harm', and random samples of a proportion of 'Low harm' or 'No harm' incidents. PSIs and contributory factors were classified through qualitative content analysis using existing frameworks. Frequencies and proportions of incident types were computed, and reporter-identified solutions were inductively categorized.

Results: Of 1825 sampled reports, 1443 were eligible and classified into nine categories. Harmful outcomes, wherein service influence was unclear, were widely observed, with self-harm the modal concern amongst 'No harm' (15.0%), 'Low harm' (62.8%), and 'Moderate harm' (37.6%) categories. Attempted suicides (51.7%) and suicides (52.1%) were the most frequently reported events under 'Severe harm' or 'Death' outcomes, respectively. Incidents common to most healthcare settings were identified (e.g. medication errors), alongside specialty-specific incidents (e.g. Mental Health Act administration errors). Contributory factors were wide-ranging, with situational failures (e.g. team function failures) and local working conditions (e.g. unmanageable workload) widely reported. Solution categories included service user-directed actions and policy introduction or reinforcement.

Conclusions: Study findings provide novel insights into incidents, contributory factors, and reported solutions within community-based mental healthcare. Targets for safety improvement are outlined, aimed at strengthening system-based prevention of incidents.

Background: Previous studies (various designs) present contradicting insights on the potential causal effects of diet/physical activity on depression/anxiety (and vice versa). To clarify this, we employed a triangulation framework including three methods with unique strengths/limitations/potential biases to examine possible bidirectional causal effects of diet/physical activity on depression/anxiety.

Methods: Study 1: 3-wave longitudinal study (n = 9,276 Dutch University students). Using random intercept cross-lagged panel models to study temporal associations. Study 2: cross-sectional study (n = 341 monozygotic and n = 415 dizygotic Australian adult twin pairs). Using a co-twin control design to separate genetic/environmental confounding. Study 3: Mendelian randomization utilizing data (European ancestry) from genome-wide association studies (n varied between 17,310 and 447,401). Using genetic variants as instrumental variables to study causal inference.

Results: Study 1 did not provide support for bidirectional causal effects between diet/physical activity and symptoms of depression/anxiety. Study 2 did provide support for causal effects between fruit/vegetable intake and symptoms of depression/anxiety, mixed support for causal effects between physical activity and symptoms of depression/anxiety, and no support for causal effects between sweet/savoury snack intake and symptoms of depression/anxiety. Study 3 provides support for a causal effect from increased fruit intake to the increased likelihood of anxiety. No support was found for other pathways. Adjusting the analyses including diet for physical activity (and vice versa) did not change the conclusions in any study.

Conclusions: Triangulating the evidence across the studies did not provide compelling support for causal effects of diet/physical activity on depression/anxiety or vice versa.

Background: An accumulating body of evidence indicates that peripheral physiological rhythms help regulate and organize large-scale brain activity. Given that schizophrenia (SZ) is characterized by marked abnormalities in oscillatory cortical activity as well as changes in autonomic function, the present study aimed to identify mechanisms by which central and autonomic nervous system deficits may be related. We evaluated phase-amplitude coupling (PAC) as a physiological mechanism through which autonomic nervous system (ANS) and central nervous system (CNS) activity are integrated and that may be disrupted in SZ.

Methods: PAC was measured between high-frequency heart rate variability (HF-HRV) as an index of parasympathetic activity and electroencephalography (EEG) oscillations in 36 individuals with first-episode SZ and 38 healthy comparison participants at rest.

Results: HRV-EEG coupling was lower in SZ in the alpha and theta bands, and HRV-EEG coupling uniquely predicted group membership, whereas HRV and EEG power alone did not. HRV-EEG coupling in the alpha band correlated with measures of sustained attention in SZ. Granger causality analyses indicated a stronger heart-to-brain effect than brain-to-heart effect, consistent across groups.

Conclusions: Lower HRV-EEG coupling provides evidence of deficient autonomic regulation of cortical activity in SZ, suggesting that patterns of dysconnectivity observed in brain networks extend to brain-body interactions. Deficient ANS-CNS integration in SZ may foster a breakdown in the spatiotemporal organization of cortical activity, which may contribute to core cognitive impairments in SZ such as dysregulated attention. These findings encourage pursuit of therapies targeting autonomic function for the treatment of SZ.

Background: The structure of psychopathology can be organized hierarchically into a set of transdiagnostic dimensional phenotypes. No studies have examined whether these phenotypes are associated with brain structure or dementia in older adults.

Methods: Data were drawn from a longitudinal study of older adults aged 70-90 years at baseline (N = 1072; 44.8% male). Confirmatory factor models were fit to baseline psychiatric symptoms, with model fit assessed via traditional fit indices, model-based reliability estimates, and evaluation of model parameters. Bayesian plausible values were generated from the best-fitting model for use in subsequent analyses. Linear mixed models examined intraindividual change in global and regional gray matter volume (GMV) and cortical thickness over 6 years. Logistic regression examined whether symptom dimensions predicted incident dementia over 12 years.

Results: A higher-order model showed a good fit to the data (BIC = 28,691.85; ssaBIC = 28,396.47; CFI = 0.926; TLI = 0.92; RMSEA = 0.047), including a general factor and lower-order dimensions of internalizing, disinhibited externalizing, and substance use. Baseline symptom dimensions did not predict change over time in total cortical and subcortical GMV or average cortical thickness; regional GMV or cortical thickness in the frontal, parietal, temporal, or occipital lobes; or regional GMV in the hippocampus and cerebellum (all p-values >0.5). Finally, baseline symptom dimensions did not predict incident dementia across follow-ups (all p-values >0.5).

Conclusions: We found no evidence that transdiagnostic dimensions are associated with gray matter structure or dementia in older adults. Future research should examine these relationships using psychiatric indicators capturing past history of chronic mental illness rather than current symptoms.