Psychiatry Investigation最新文献

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.

Objective: Medication adherence is crucial for long-term outcomes in bipolar disorder. Despite the rising use of aripiprazole, a longacting injectable for bipolar disorder, once monthly to improve adherence and manage side effects, research on its effects in South Korean patients with bipolar disorder is limited.

Methods: In this non-interventional, retrospective study, medical records were used to analyze aripiprazole once monthly treatment from its initiation in routine clinical settings. The data were collected at 1, 3, 6, 9, and 12 months. Functional level and symptom severity were measured using the Global Assessment of Functioning (GAF), Clinical Global Impression-Bipolar-Severity (CGI-BP-S), Young Mania Rating Scale (YMRS), Korean version of the Montgomery-Åsberg Depression Rating Scale (K-MADRS), and Hamilton Anxiety Rating Scale (HAM-A). Additionally, the dosages and number of pills of mood stabilizers and antipsychotics, and the total number of medications, were recorded.

Results: Among 24 patients with bipolar disorder, significant functional improvement and symptom relief were observed over 1 year, with a significant reduction in total pill count and dosages of mood stabilizers and antipsychotics. Specifically, the GAF score increased by 25.7% (p=0.001), while CGI-BP-S, YMRS, K-MADRS, and HAM-A scores decreased by 24.4% (p=0.001), 81.2% (p=0.001), 36.2% (p=0.002), and 36.1% (p=0.003), respectively. Six patients reported side effects such as akathisia, tremors, weight gain, and headache, but no severe adverse effects were noted.

Conclusion: This study showed significant improvement in functional outcomes and mood symptoms with monthly aripiprazole treatment in bipolar disorder. Mood stabilizer and antipsychotic dosages were also reduced. The results highlight the proactive role of longacting injectable antipsychotics in enhancing functioning, symptoms, and quality of life in bipolar disorder.

Objective: Perinatal depression often remains undertreated due to concerns about antidepressant exposure during fertility treatment, pregnancy, or breastfeeding. Non-pharmacological, home-based interventions such as transcranial direct current stimulation (tDCS) present a promising alternative; however, real-world evidence in perinatal populations remains limited.

Methods: This prospective observational study included 38 women who received infertility, pregnancy, or postpartum treatment at four hospitals in South Korea. Participants self-administered anodal tDCS targeting the left dorsolateral prefrontal cortex for 20-28 sessions over 4 weeks. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and weeks 2, 4, and 8. Subjective health perception was measured at baseline using a 5-point Likert scale.

Results: Time had a significant effect on depressive symptoms (Wald χ2=90.75, p<0.001), with the largest reduction observed during the first 2 weeks. The CES-D scores remained significantly lower than baseline at week 8, 4 weeks after treatment ended. Subjective health perception was significantly associated with baseline depression severity (Wald χ2=26.41, p<0.001), and its interaction with time was also significant (Wald χ2=320.18, p<0.001). Participants with poorer perceived health (scores 4-5) experienced greater depressive symptom reductions than those with more favorable perceptions (scores 1-2).

Conclusion: Home-based tDCS was feasible and associated with clinically meaningful improvement in depressive symptoms among perinatal women. Those who initially perceived their health more negatively showed greater response, suggesting subjective health perception may serve as a useful moderator and potential marker to inform personalized treatment strategies.

Objective: Adolescent depressive symptoms are increasingly recognized as a global concern for youth mental health. Female adolescents consistently report higher levels of depressive symptoms than their male counterparts, yet the psychological mechanisms underlying depressive symptoms remain insufficiently understood. Our longitudinal study examined the relationship between loneliness and depressive symptoms in female adolescents and investigated the mediating effect of subjective well-being (SWB) and the moderating influence of the parental relationship.

Methods: Data were drawn from the Korean Study of Adolescent Health, a longitudinal study on adolescent mental health. The sample included 104 female high school students (mean age=15.33 years) who completed self-report surveys at three time points between April 2022 and July 2023. Measures assessed loneliness, SWB, depressive symptoms, and relationships with mothers and fathers. Mediation and moderated mediation analyses were conducted using SPSS PROCESS (Models 4 and 14), controlling for age, socioeconomic status, and baseline depressive symptoms.

Results: Mediation analyses indicated that SWB fully mediated the longitudinal association between loneliness and depressive symptoms. Loneliness predicted lower SWB, which subsequently predicted more depressive symptoms. Moderated mediation analysis revealed that maternal, but not paternal, relationship quality significantly moderated the SWB-depressive symptoms link. The indirect effect was significant only among adolescents reporting stronger maternal relationships.

Conclusion: These findings underscore the importance of SWB in the link between loneliness and depressive symptoms among female adolescents and highlight the protective role of a positive maternal relationship. The results have implications for targeted prevention and intervention strategies to enhance emotional well-being in female adolescents.