Psychiatry and Clinical Neurosciences最新文献

Aim: This network meta-analysis of randomized controlled trials (RCTs) aimed to investigate which hypnotics are associated with the most favorable sleep architecture and respiratory outcomes in adults with obstructive sleep apnea.

Methods: Primary outcomes included total sleep time (TST) and apnea-hypopnea index (AHI) during TST. Other outcomes were rapid eye movement (REM) sleep time, latency to persistent sleep (LPS), wake after sleep onset (WASO), sleep efficiency (SE), AHI during non-REM or REM sleep, mean peripheral oxygen saturation (SpO₂) during TST, mean SpO₂ nadir during TST, arousal index (AI), all-cause discontinuation, adverse event-related discontinuation, and incidence of individual adverse events. Effect sizes with 95% confidence intervals were calculated.

Results: This systematic review included 32 RCTs (n = 1871, average age = 51.60 years, 62.52% male, mean AHI = 23.60). Our network meta-analysis evaluated brotizolam, daridorexant, eszopiclone, flurazepam, lemborexant, nitrazepam, ramelteon, temazepam, triazolam, zaleplon, zolpidem, zopiclone, and placebo. Compared with placebo, lemborexant increased TST, REM sleep time, and SE and decreased LPS and WASO, whereas both daridorexant and zolpidem increased TST and SE and decreased WASO. These three medications demonstrated respiratory safety and discontinuation profiles similar to those of placebo. Eszopiclone increased TST and SE and decreased LPS, WASO, AHI during TST, and AI, but its effects on LPS, WASO, AHI during TST, and AI disappeared in the sensitivity analysis, excluding continuous positive airway pressure titration studies.

Conclusion: Our network meta-analysis identified different effects of various hypnotics on sleep architecture and respiratory parameters; however, the lack of data prevented a formal synthesis of subjective outcomes. Therefore, these results should be interpreted with caution in clinical practice.

Major depressive disorder (MDD) remains a highly heterogeneous condition, presenting significant challenges for effective diagnosis and treatment. Traditional diagnostic systems often fail to capture the diverse clinical and biological phenotypes of MDD, limiting the efficacy and predictability of therapeutic interventions. The advent of wearable technology has enabled the continuous collection of real-time, objective data. By leveraging advanced artificial intelligence (AI) methodologies, these data streams can be transformed into dynamic digital phenotypes that may correlate with the complex psychopathological manifestations of depression. This integration offers a novel, data-driven approach to augment traditional subjective assessments, paving the way for more precise classification and personalized treatment strategies. This review explores the potential of AI-enhanced digital phenotyping to revolutionize depression diagnosis and management, advocating for a paradigm shift toward a more personalized, precision-based approach in psychiatric practice.

Although there is a plethora of studies related to quality of life (QoL), little is known about QoL in prison settings. Emotions and difficulties in emotional regulation in incarcerated individuals may affect inmates' QoL and also their ability to reintegrate into society. The purpose of this review was to compile the empirical evidence and identify knowledge gaps to make suggestions for enhancing QoL in correctional environments. This narrative review includes research published between 2014 and 2024 in PubMed, Google Scholar, EBSCO, and Embase on inmates' QoL, emotion regulation, and mental health. Research on forensic patients as well as non-English articles was excluded. Emotions and emotion regulation were interlinked with mental health issues, while social support was the most eminent feature promoting overall QoL in prisoners, along with other systemic and environmental aspects. Our narrative review suggests that the research to date is limited, focused on male and young inmates, and based on self-reported cross-sectional data. From a public health perspective, identifying the impact of emotions and mental health in the prison population could help improve the QoL of prisoners and inform research, rehabilitation programs, and correctional policy.

Aim: Bipolar disorder (BD) and schizophrenia (SCZ) share many clinical and neurobiological features, and a continuum between the two has been postulated. Bipolar patients leaning toward the SCZ pole of the continuum may have a higher risk of neuroprogression. Here we investigated the relationships between illness course, white matter integrity, levels of N-acetylaspartate (NAA), and polygenic score (PRS) of SCZ.

Methods: A sample of 103 depressed bipolar inpatients underwent magnetic resonance imaging (MRI) acquisition to perform diffusion tensor imaging (DTI) analysis and magnetic resonance spectroscopy to assess NAA. Genotyping and PRS calculation were also performed in a subsample of 75 patients. Associations between illness course, NAA, and white matter microstructure were explored; indirect effects were investigated through mediation models; further, a possible moderating effect of SCZ-PRS was tested.

Results: Negative associations emerged between number of affective episodes and NAA. Manic episodes were also negatively associated with white matter integrity, and NAA significantly mediated the effect of manic episodes on DTI metrics. SCZ-PRS moderated the relation between illness duration and NAA. Moderated mediation analyses showed that only at high SCZ-PRS, illness duration negatively affected NAA, which in turn was linked to reduced fractional anisotropy.

Conclusion: Our results support the concept of neuroprogression in BD, suggesting a deleterious effect of acute episodes, particularly manic ones, on neurochemical and white matter alterations. Further, patients with a higher SCZ-PRS seem to show detrimental effects related to illness duration, possibly suggesting a longitudinal course closer to SCZ.

Aim: To investigate abnormal patterns of intrinsic neural timescales (INT) in first-episode schizophrenia across different ages of onset, with a focus on differences in neural temporal-dynamic characteristics between early-onset and adult-onset patients.

Methods: We collected resting-state fMRI data from 231 first-episode schizophrenia patients (early-onset, n = 122; adult-onset, n = 109) and 153 healthy controls (younger controls, n = 61; older controls, n = 92). INT was computed from the autocorrelation function of the fMRI signal. A two-way ANOVA tested the Diagnosis × Age-of-onset interaction. Further analyses included between-group comparisons, correlation analyses, and imaging transcriptomic analysis.

Results: Fourteen region of interests (ROIs) showed significant interaction effects (P < 0.05/264), predominantly located within the default mode network (DMN, 9 ROIs), with additional involvement of sensorimotor, frontoparietal, memory retrieval, and dorsal attention networks. Group comparisons indicated that early-onset patients exhibited more widespread INT reductions across multiple regions relative to age-matched controls, whereas INT abnormalities in adult-onset patients were more restricted and primarily centered on the DMN. Interaction effects on INT were possibly associated with gene enrichment related to chemical synaptic transmission, glutamatergic signaling, and calcium/calmodulin-dependent kinase activity.

Conclusion: INT abnormalities in first-episode schizophrenia are dependent on age of onset: the early-onset subtype shows widespread shortening of timescales across multiple brain networks, suggesting broad neurodevelopmental compromise, whereas the adult-onset subtype exhibits more focal abnormalities centered on the DMN. These findings suggested that INT may serve as a potential neuroimaging biomarker for distinguishing onset-age subtypes, aiding precise stratification and mechanistic studies of schizophrenia.

Aim: Bipolar disorder (BD) is commonly misdiagnosed as major depressive disorder (MDD) due to depression often preceding manic symptoms. Yet, neurobiological mechanisms underlying emotional states transition in depressed patients remain largely unexplored.

Methods: Leveraging a lifespan normative model from a large healthy cohort (N = 1262), we quantified the structural or functional brain variability for 389 depressed patients (179 MDD, 138 BD, 72 transition to BD [tBD]). The MDD and tBD patients were followed up for 6~13 years. A dimensional approach was employed to dissect the neuroimaging variability across different clinical dimensions in MDD and BD patients, represented as the transdiagnostic covariation modes between clinical risk factors for emotional states transition and brain structural or functional variability.

Results: Two covariation modes were identified: Mode 1, tied to earlier age of onset, exhibited reduced activity in limbic/subcortical networks and increased activity in dorsal attention, executive control networks, which facilitated differentiating BD from MDD; Mode 2, associated with the retardation symptom, revealed gray matter atrophy in default mode, limbic and subcortical networks, whose structural pattern identified tBD from MDD. Multifaceted genetic landscape underpinning the structural pattern in Mode 2 suggested dopamine (specifically DRD2-related genetic risk) showed a significant association with the structural deficits in reward circuit, covary with the changes of retardation symptom.

Conclusion: Our findings aid in better understanding the underlying neurobiological mechanisms of emotional states transition and clinically subtle symptom changes in early-stage BD patients who have never experienced a mania/hypomania episode, providing important target information for early intervention in BD.

Aim: Adherence to the Mediterranean-dietary approaches to stop hypertension (DASH) intervention for neurodegenerative delay (MIND) diet has been associated with a reduced risk of dementia, yet clinical and mechanistic evidence is limited. This study aims to explore the relationship between MIND diet adherence and cognitive function in Alzheimer's disease (AD), with a specific focus on resting-state EEG to investigate the underlying mechanisms.

Methods: We evaluated 841 memory clinic participants: 119 cognitively normal, 255 with mild cognitive impairment, and 467 with AD. Cognitive, dietary, neuropsychiatric, and functional data were collected. EEG from 204 participants was analyzed for spectral and connectivity features.

Results: MIND scores were significantly lower in the AD group (P < 0.001). Higher MIND adherence was linked to better global cognition, lower dementia severity, fewer mood symptoms, and greater daily functioning (P < 0.05). Individuals in the lowest adherence tertile had 6.78 times higher odds of cognitive impairment compared to those in the highest tertile (OR = 6.78, 95% CI: 4.54-10.13, P < 0.001). EEG analyses revealed that greater MIND adherence was associated with increased alpha power, reduced occipital theta/beta and delta/alpha ratios, and stronger frontoparietal connectivity. Mediation analysis indicated that frontal and global alpha power partially mediated the associations between MIND diet adherence and dementia severity, mood symptoms, and functional status.

Conclusions: High MIND adherence is associated with improved cognitive and functional outcomes in AD. EEG signatures may partially mediate these effects, highlighting the clinical potential of the MIND diet for early intervention and neurophysiological monitoring.

Aim: To determine whether catatonia is associated with increased long-term all-cause and cause-specific mortality.

Methods: Using Taiwan's National Health Insurance Database (2000-2022), we assembled a population-based cohort of all adults (≥18 years) with catatonia and matched each to four controls without catatonia on sex and birthdate. Mortality was compared between (1) individuals with catatonia and their unaffected siblings and (2) individuals with schizophrenia spectrum disorders with catatonia and those with schizophrenia spectrum disorders without catatonia. The primary outcome was all-cause mortality; secondary outcomes were natural- and unnatural-cause deaths. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with Cox models controlling for age, sex, socioeconomic status, urbanization level, and comorbidities.

Results: We included 6642 individuals with catatonia and 26,568 matched controls. Over mean follow-ups of 11.4 and 13.1 years, respectively, 2150 versus 3459 deaths occurred (adjusted HR 2.60, 95% CI 2.46-2.75). Risks were higher for natural causes (2.42, 2.28-2.57) and unnatural causes (5.57, 4.59-6.77). Compared with unaffected siblings, catatonia remained associated with excess all-cause (1.82, 1.34-2.49), natural (1.57, 1.07-2.30), and unnatural mortality (2.73, 1.56-4.77). Within schizophrenia spectrum disorders, catatonia conferred higher all-cause (1.20, 1.12-1.28) and natural mortality (1.27, 1.18-1.36), whereas unnatural mortality was similar (1.01, 0.87-1.17).

Conclusions: Catatonia conferred a substantial, independent risk of premature mortality across multiple causes. Clinicians should recognize that catatonia is a serious disorder with long-term consequences and should remain vigilant to prevent and manage complications beyond the acute episode.

Aim: Noninvasive neuromodulation techniques, including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial focused ultrasound stimulation (tFUS), are promising interventions for acute treatment of depressive episodes. However, the comparative efficacy and acceptability of stimulation protocols remain unclear. This network meta-analysis (NMA) aimed to compare the efficacy and tolerability of various noninvasive neuromodulation strategies.

Methods: We conducted a systematic review and NMA of randomized controlled trials (RCTs) enrolling patients with major depressive disorder or bipolar depression, including nine repetitive TMS (rTMS) protocols, three theta burst stimulation (TBS) protocols, as well as tDCS and tFUS. Primary outcomes were response and all-cause discontinuation rates. Subgroup analyses examined treatment-resistant depression (TRD) and monotherapy versus add-on therapy.

Results: A total of 129 RCTs (7667 patients; 272 treatment arms) were included. All protocols except low-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) showed higher response rates than sham. tFUS demonstrated the highest response rate (OR: 7.24, 95% CI: 1.35-38.47), followed by bilateral rTMS (OR: 5.75, 95% CI: 3.29-10.07) and bilateral TBS (OR: 5.37, 95% CI: 2.51-11.36), both effective for general depression and TRD. Bilateral TBS showed the highest response rate when administered as monotherapy, whereas bilateral rTMS was most effective as add-on therapy. Most studies (87.6%) were rated as having low or unclear risk of bias.

Conclusions: Our findings provide preliminary evidence that bilateral stimulation over DLPFC is more beneficial than unilateral stimulation for treating depressive episodes. Nonetheless, tFUS may represent a highly promising novel intervention warranting further investigation.