Psychiatry Investigation最新文献

Objective: The incidence of psychiatric illnesses might be higher in individuals people living with human immunodeficiency virus (PLWH) than in individuals without human immunodeficiency virus (HIV). We aimed to investigate whether PLWH had different risks of psychiatric morbidities in comparison to non-HIV-infected individuals.

Methods: This study included all PLWH in South Korea between January 1, 2017 and December 31, 2017. The control group, which had never been diagnosed with HIV, was selected using a 1:10 stratified random sampling technique, considering age and sex. The endpoint of this study was new diagnosis of psychiatric morbidities which were diagnosed from January 1, 2018 to December 31, 2022.

Results: After conducting a 1:5 propensity score (PS) matching process, the final analysis comprised a group of 17,815 PLWH and 78,021 control subjects. In the PS-matched cohort, the incidence rate of psychiatric morbidity in PLWH was 5,677.7 per 100,000 per year, whereas that in the controls was 4,926.3 per 100,000 per year. In Cox regression in the PS-matched cohort, PLWH showed 17% (hazard ratio, 1.17; 95% confidence interval, 1.14-1.21; p<0.001) higher risk of psychiatric morbidity than controls. Specifically, PLWH showed higher risk of depression, mania, bipolar disorder, insomnia disorder, substance use disorder, and schizophrenia compared to controls.

Conclusion: PLWH had a greater likelihood of experiencing psychiatric morbidities compared to those without HIV in South Korea. Our research findings indicate the importance of public health policy in addressing the declining mental health of individuals living with HIV.

Objective: Disasters such as pandemics and natural catastrophes cause significant psychological distress, increasing the risk of depression, anxiety, and post-traumatic stress disorder (PTSD). This review aimed to evaluate the effectiveness of remote mental health interventions, such as telepsychiatry, online cognitive behavioral therapy (CBT), mobile applications, and artificial intelligence (AI)-based tools, during disasters.

Methods: A comprehensive literature search was conducted using international databases (PubMed, EMBASE, PsycINFO, Web of Science, Scopus, CINAHL) and Korean domestic databases (KISS, RISS, DBpia, KMbase, KoreaMed). Studies published between January 2010 and February 2025 were screened following the PRISMA 2020 guidelines. Two board-certified psychiatrists independently reviewed titles, abstracts, and full texts. Peer-reviewed articles and relevant grey literature, including government manuals and expert guidelines, were included.

Results: A total of 147 studies were synthesized, including randomized controlled trials, meta-analyses, observational studies, and policy documents. Evidence showed that remote interventions effectively reduced symptoms of depression, anxiety, and PTSD. Online CBT was beneficial for mild to moderate distress; mobile apps facilitated psychoeducation and symptom tracking; and telepsychiatry ensured care continuity, especially in underserved areas. AI tools showed promise in screening and triage but require better clinical integration. Effectiveness was highest when interventions were implemented early, integrated within stepped-care models, and guided by trained professionals.

Conclusion: Remote mental health interventions are practical and effective tools for bridging mental health care gaps during disasters. To ensure sustainability, these interventions should be integrated into national disaster mental health frameworks, accompanied by adequate funding, clinician training, legal safeguards, and cultural adaptation.

Objective: The study was to develop the instrumental activities of daily living scale-ability and actual performance (IADL-AA) to assess the ability and actual performance constructs of instrumental activities of daily living (IADL).

Methods: Eight experts reviewed the items of the IADL-AA. Additionally, 30 and 266 people with schizophrenia participated in cognitive interviews and validation analysis, respectively. Expert consultations and cognitive interviews were conducted to examine face validity and content validity, respectively. Construct validity was evaluated through Rasch analysis to ensure unidimensionality. Convergent validity was investigated using Pearson's r, discriminative validity was examined through floor and ceiling effects, and internal consistency was assessed using Cronbach's alpha (α).

Results: The IADL-AA comprised 23 items showing the unidimensionality of each domain. The infit and outfit mean squares were 0.76-1.21 and 0.68-1.40, respectively. A moderate correlation was observed between ability and actual performance domains (r=0.63). No floor or ceiling effects were found for the two domains (0.0%-6.0% and 1.5%-3.0%, respectively). Cronbach's α of the two domains was 0.83-0.90.

Conclusion: The IADL-AA demonstrates satisfactory psychometric properties, including face validity, content validity, construct validity, convergent validity, discriminative validity, and internal consistency. This measure can effectively identify the capacity and degree of independence of IADL function in people with schizophrenia.

Objective: This study aimed to develop a reliable and valid Mixed State Severity Index (MSSI) to assess mood instability in patients with mood disorders and determine cutoff scores.

Methods: Twenty-one items were selected based on Koukopoulos' criteria for mixed depressive episode, historically referred to as agitated depression, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision mixed features criteria. The MSSI was administered to 242 patients (major depressive disorder [n=92], bipolar disorder [BD] I [n=78], and BD II [n=72]) and 726 controls.

Results: The MSSI demonstrated high internal consistency (α=0.78-0.90). Exploratory factor analysis revealed a stable four-factor structure. Based on receiver operating characteristic analysis, optimal cutoff scores were identified to distinguish mood disorder groups from controls, ranging from 19.5 to 27.5 depending on diagnosis.

Conclusion: The MSSI is a reliable and valid instrument for assessing the severity of mixed features in patients with mood disorders. The established cutoff scores enhance its clinical utility, providing robust diagnosis and treatment planning support.

Objective: This study investigated whether quantitative electroencephalography (qEEG) features, combined with clinical data, could predict treatment outcomes in female adolescents with non-suicidal self-injury (NSSI).

Methods: We analyzed clinical and EEG data from 104 female adolescent inpatients with repetitive NSSI. Resting-state EEG was recorded, and various brain activity patterns across frequency bands were extracted. Clinical outcomes were assessed using pre- and postadmission scores on the Health of the Nation Outcome Scales (HoNOS), Clinical Global Impression-Severity (CGI-S), World Health Organization Disability Assessment Schedule (WHODAS), and Global Assessment of Functioning (GAF). Machine learning models were trained to predict outcomes using EEG and medication data. Model performance was evaluated using cross-validation, and feature importance was interpreted using SHapley Additive exPlanations (SHAP) analysis.

Results: All predictive models demonstrated excellent predictive performance (R2≥0.96, mean squared error [MSE] as low as 0.02). The HoNOS model showed the highest performance (R2=0.99, MSE=0.32), followed by the WHODAS (R2=0.98, MSE=1.32), GAF (R2=0.97, MSE=0.76), and CGI-S (R2=0.96, MSE=0.02) models. Key qEEG predictors included relative low-beta power at Pz, absolute theta power at Fp1, and the delta-to-beta ratio at Cz. Pre-admission clinical severity, particularly CGI-S and HoNOS, also significantly contributed to prediction accuracy.

Conclusion: Our findings suggest that qEEG features, combined with machine learning, can effectively predict treatment response in adolescents with NSSI, supporting their use as neurophysiological biomarkers for individualized care.

Objective: Cognitive interventions (CIs) are recognized for enhancing cognition and mitigating cognitive decline in dementia patients. Our study assessed the effects of a 12-week, home-based, robot-assisted CI on cognition and brain function in patients with mild Alzheimer's disease (AD) dementia.

Methods: In this single-blind randomized controlled trial, 51 patients with mild AD dementia were assigned to either a robot-assisted CI group (n=27) or a waitlist control group (n=24). The CI was conducted for 60 minutes per day over 12 weeks. The primary outcome was brain function, measured by resting-state electroencephalogram (EEG) using a 19-channel wireless EEG device and the secondary outcome was cognitive function, measured using the Cambridge Neuropsychological Test Automated Battery. No significant baseline demographic or clinical differences were observed between the groups. Eighteen participants in the robot group and 19 in the control group completed the study.

Results: EEG analysis revealed a decrease in theta band activity in the mid-frontal area for the robot group, while the control group exhibited an increase in this area. In addition, the robot group showed significant cognitive improvements in working memory, visual association memory, and reaction time after the 12-week CIs.

Conclusion: These findings suggest that robot-assisted CIs may be associated with enhanced cognitive and brain function in patients with mild AD dementia.

Objective: Depression involves mood-related behavioral changes typically monitored through subjective reports, which are limited by recall bias and low temporal resolution. Digital mental health tools offer objective, continuous monitoring, but prior studies have focused on outpatients subject to environmental variability. In this preliminary feasibility study, we examined psychiatric inpatients in a controlled setting to assess associations between behavioral regularity and depression severity, highlighting the clinical potential of digital phenotyping.

Methods: Thirty-five adults from a closed psychiatric ward were recruited, and data from 10 inpatients with ≥7 days of valid monitoring were analyzed. Depression severity was assessed weekly using the Hamilton Depression Rating Scale (HAMD) and Dysfunctional Self-focus Attributes Scale, yielding 18 samples. Hourly accelerometer and location data from wearable devices and ward sensors were processed to generate digital phenotypes-interdaily stability (IS), intradaily variability (IV), ratio of IS to IV (ISV), entropy (EN), and normalized entropy (NE)-segmented into daytime and nighttime. Linear mixed models assessed group differences, and correlation and multiple regression examined associations with depression.

Results: Patients with asymptomatic/mild depression showed significantly higher IS_day and ISV_day, and lower EN_night, and NE_night (all p<0.05). These four features correlated with HAMD after false discovery rate (all p<0.05) correction. A regression model including IS_day and NE_night explained 60.6% of HAMD variance (p<0.05).

Conclusion: Digital monitoring provides an objective and continuous method to assess depression severity. By capturing macro- and micro-level movement regularity across day and night in an inpatient environment, this approach offers practical relevance for psychiatric care. However, results should be considered preliminary due to the limited sample size.

Objective: Both acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) for obsessive-compulsive disorder (OCD) target metacognition. In this context, ACT's therapeutic effects on OCD are presumably reflected in the Obsessive Belief Questionnaire (OBQ), which incorporates significant metacognitive factors. However, most studies have investigated ACT's effects on OCD symptoms rather than on obsessive beliefs.

Methods: This study examined the relationship between ACT process measures-Acceptance and Action Questionnaire-II (AAQ-II) and Cognitive Fusion Questionnaire (CFQ)-and the OBQ following an 8-week group-format ACT (GACT) intervention among patients with OCD (GACT group, n=37; wait-list control group, n=42).

Results: Significant reductions were observed in AAQ-II, CFQ, and OBQ scores after treatment. Changes in AAQ-II and CFQ (particularly in the former) were significantly associated with changes in the OBQ total and subscale scores. These measures accounted for 26% and 12% of the variance in the OBQ total score and OCD symptom scores, respectively. Among OBQ subscales, changes in AAQ-II and CFQ best accounted for the variance of perfectionism and intolerance of uncertainty (OBQ-PU), followed by importance and control of thoughts (OBQ-ICT).

Conclusion: Improvements in ACT process measures through GACT were more strongly linked to obsessive beliefs than to OCD symptoms, highlighting the role of obsessive beliefs-particularly OBQ-PU and OBQ-ICT-in ACT's effectiveness for OCD.

Objective: To assess the incidence and risk of psychiatric disorders, including depression, anxiety, and trauma-related disorders, in individuals who underwent globe and orbital ablative surgeries compared to a matched control group.

Methods: This retrospective cohort study used Korean National Health Insurance Service data. The cohort included 338,767 individuals, with 16,545 in the surgery group (orbital exenteration, enucleation, or evisceration, 2003-2021) and 322,222 matched controls. After exclusions, 12,965 patients were matched with 251,445 controls via propensity score matching. The cumulative incidence and risk of psychiatric disorders, including depression (F32.x, F34.0, F34.1), anxiety (F40.x, F41.x), and trauma-related disorders (F43.x), over three years post-surgery. Kaplan-Meier analysis assessed cumulative incidence, while Cox proportional hazards regression estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: A total of 264,410 individuals (mean age, 54.4 years; 63.3% man) were included. The surgery group had significantly higher cumulative incidence of psychiatric disorders (log-rank p<0.001). The incidence rate ratio was 1.63 (95% CI, 1.52-1.75). Risk was greatest in younger individuals (incidence rate ratio, 2.15; 95% CI, 1.75-2.64) and men (1.77 vs. 1.48 in women). Higher comorbidities were associated with lower risk (HR: 0.91 in men, 0.90 in women), as was higher socioeconomic status (HR: 0.76 in men, 0.68 in women).

Conclusion: Globe and orbital ablative surgeries were associated with significantly increased psychiatric risk, particularly in younger men. Higher comorbidities and socioeconomic status appeared to mitigate this risk. Integrated mental health support should be considered in postoperative care.