Psychiatry Investigation最新文献

Objective: Suicidal behavior among adolescents has become increasingly prevalent in recent years, positioning suicide as one of the leading causes of death in this age group worldwide. Despite this growing public health concern, country-specific data remain limited, particularly in Türkiye. This study aimed to examine the sociodemographic and clinical characteristics of adolescents referred to psychiatric services following a suicide attempt in Türkiye.

Methods: We enrolled adolescents (12-18 years) who presented to the Pediatric Emergency Department after a suicide attempt and were subsequently referred to our clinic. Participants completed a Sociodemographic Data Form and underwent the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version interview to assess lifetime psychiatric diagnoses.

Results: Among the 60 participants, 86.7% were female and 13.3% were male. The mean age was 184.7±13.6 months (range: 144-211 months). Two-thirds (66.7%) met criteria for at least one psychiatric disorder; major depressive disorder was most prevalent (41.7%). The predominant method of attempt was medication ingestion, and family conflict was identified as the leading precipitant (56.7%). A history of prior suicide attempts was reported by 40%, and 33.3% had a family history of suicide. Notably, 70% had engaged in non-suicidal self-harming behavior (SHB) before their attempt.

Conclusion: Suicide attempts peak during middle adolescence, and female adolescents are at higher risk. Clinicians should monitor warning signs such as a prior history of SHB. Given the high prevalence of psychiatric disorders in both these adolescents and their parents, early identification and intervention are essential to prevention.

Objective: We aimed to investigate whether the risks of suicide and non-suicide death vary based on the presence of psychiatric disorders.

Methods: Patients diagnosed with psychiatric disorders in South Korea between January 1, 2017, and December 31, 2017, were included and referred to as the psychiatric disorder (PY) group. A comparison group, the non-PY group, included individuals who had never been diagnosed with psychiatric disorders, selected using a 1:1 stratified random sampling technique based on age and sex. The patients were followed up for death by suicide (primary endpoint) from January 1, 2018 to December 31, 2022. All other causes of death were categorized as non-suicidal deaths.

Results: After 1:1 propensity score (PS) matching, 761,384 adult participants (380,692 in each group) were finally included. Of these, 0.2% (830/380,692) of individuals in the PY group died by suicide, compared with <0.01% (13/380,692) in the non-PY group. The PY group had a 64.43-fold higher risk of suicide death (hazard ratio [HR]: 64.43, 95% confidence interval [CI]: 37.25-111.43, p<0.001) compared to the non-PY group. Additionally, 8.6% (32,746/380,692) of the PY group died from non-suicidal causes, while 7.1% (27,043/380,692) of the non-PY group died from non-suicidal causes. PY group had a 1.22-fold higher risk of non-suicidal death (HR: 1.22, 95% CI: 1.20-1.24, p<0.001) compared to the non-PY group.

Conclusion: Psychiatric disorders were associated with a significantly elevated suicidal risk in South Korea, which was substantially greater than the risk of non-suicidal deaths.

Objective: Employment status is a key indicator of socioeconomic status, and unstable employment conditions can cause various social problems. However, research in Asian populations on the association between employment status and mental health, particularly suicidal ideation, remains relatively limited. This study investigated the association between employment status and suicidal ideation in general population in South Korea.

Methods: Using data from the 2015, 2017, and 2019 Korea National Health and Nutrition Examination Survey (KNHANES), 6,509 participants aged ≥20 years were analyzed. Suicidal ideation was characterized by individuals considering suicide seriously within the past year. Covariates were adjusted to account for factors such as sociodemographic, health behavior, and mental health factors. Multivariable logistic regression was performed, along with stratified analyses by subgroups of sociodemographic, health behavior, and mental health factors to assess effect modification.

Results: In our KNHANES data analysis, unemployed individuals had 1.85 times higher odds of reporting suicidal ideation compared to employed individuals (adjusted odds ratio, 1.85; 95% confidence interval, 1.41-2.44; p<0.001). In subgroup analysis, all covariates- except women and low body mass index-showed effect modification on the association between employment status and suicidal ideation.

Conclusion: This study demonstrated that unemployed status was significantly associated with increased suicidal ideation. These findings suggest that further research and policy attention are warranted to better understand and address the mental health needs of unemployed individuals.

Objective: Attention-deficit/hyperactivity disorder (ADHD) frequently persists into adulthood and leads to significant impairment across multiple domains. Cognitive behavioral therapy (CBT) has been proposed as a promising adjunctive treatment. We aimed to evaluate the effectiveness of a structured group-based CBT program for adults with ADHD and examine whether cognitive ability and treatment adherence moderate treatment response.

Methods: A retrospective analysis was conducted on 24 adults who completed a 10-session group CBT program. ADHD symptoms were assessed pre and postintervention using the Adult ADHD Self-Report Scale (ASRS) and Korean Adult ADHD Rating Scale (K-AARS). Subgroup analyses were performed based on full-scale intelligence quotient (FSIQ), session attendance, and presence of comorbid depression.

Results: A significant improvement in symptoms was observed across most ASRS and K-AARS domains. Functional impairment, as measured using the K-AARS impairment subscale, also improved significantly. Participants with an average FSIQ (90-109) showed the most consistent improvements, whereas those with below-average and high FSIQ also benefited to varying degrees. Higher attendance rates were associated with greater reduction in symptoms. The presence of comorbid depression did not significantly affect the treatment outcomes.

Conclusion: Group-based CBT is an effective adjunct intervention for managing adult ADHD symptoms. Notably, the intervention led to significant improvements in functional impairment, highlighting its potential to enhance daily functioning in adults with ADHD. Tailoring interventions based on cognitive profiles and emphasizing treatment adherence may enhance therapeutic outcomes. Future studies should employ larger sample sizes, randomized controlled designs, and longitudinal follow-up assessments to validate and extend these findings.

This case report discusses a 62-year-old male with treatment-resistant bipolar II depression and hypertension. After poor responses to multiple treatments, an add-on esketamine nasal spray (ESK-NS) was introduced in October 2022. Improvement was seen, and the patient's depressive episode was nearly remitted during the maintenance phase. However, recurrence was noted when ESK-NS frequency was reduced to once every 2 months, indicating that the dosing frequency should be adjusted cautiously. The patient experienced common side effects, including dissociation, dizziness, and transient hypertension. Nifedipine was offered when his systolic blood pressure exceeded 160 mm Hg, accompanied by headache or dizziness. Blood pressure monitoring was essential throughout ESK-NS treatment. This report highlights esketamine's potential for bipolar depression treatment and calls for further studies on its cardiovascular effects and proper management.

Objective: Major depressive disorder (MDD) is a prevalent and debilitating psychiatric condition. This study developed a group-based acceptance and commitment therapy (GACT) program for MDD and conducted a randomized controlled trial to evaluate its effectiveness. The study aims to assess the effects of GACT and identify factors influencing depression recovery in patients with MDD in Korea.

Methods: Individuals diagnosed with MDD, aged 18-40 years, were recruited. Fifty-nine participants were randomly assigned to either the GACT or waitlist control (WLC) group, with 50 participants (27 in GACT and 23 in WLC) successfully completing the program.

Results: The GACT group demonstrated significant improvements in depression symptoms (Center for Epidemiological Studies-Depression Scale, CES-D), rumination (Ruminative Response Scale-Revised, RRS-R), experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ) compared to the WLC group (all ps<0.05). Correlation and multivariate regression analyses indicated that improvements in CES-D scores were associated with changes in AAQ-II scores.

Conclusion: Our findings suggest that the 8-week GACT program has positive effects on depressive symptoms and ACT-related psychological processes in patients with MDD. This study highlights GACT as a promising group-based intervention for depression, potentially reducing the burden of individual psychological treatments.

Objective: This study aimed to evaluate the neurophysiological and cognitive effects of a tablet-based cognitive training program in cognitively unimpaired (CU) older adults, in order to explore its potential as an accessible intervention for promoting cognitive health in aging populations.

Methods: In a single-center, rater-blind randomized controlled trial, 40 CU older adults were assigned to either a 10-week tablet-based cognitive training intervention or a passive control group. Resting-state quantitative electroencephalography was conducted to assess spectral power and functional connectivity (FC) across cortical regions. Cognitive outcomes were measured using seven tests from the Cambridge Neuropsychological Test Automated Battery, covering memory, attention, and executive function domains.

Results: Compared to the control group, participants in the intervention group showed significant increases in absolute power in beta1-3, theta, and gamma frequency bands, particularly in frontal and central regions. FC analysis revealed enhanced coherence in fronto-temporal and occipital regions following the intervention. Cognitive assessment demonstrated significant improvements in memory tasks, including delayed matching to sample, paired associates learning, and pattern recognition memory, in the intervention group. No significant changes were observed in attention or executive function domains.

Conclusion: Tablet-based cognitive training was associated with measurable neurophysiological changes and selective improvements in memory performance among CU older adults. These findings support the potential of digital cognitive training as a non-pharmacological intervention to promote cognitive resilience and neural efficiency in aging. Further large-scale and long-term studies are warranted to confirm the durability and underlying mechanisms of these effects.

Objective: This study aimed to examine the current status of psychiatric therapy and anti-craving prescriptions for patients with alcohol-related diseases and to evaluate the impact of these treatments on the prognosis of alcohol-related diseases for drawing implications.

Methods: Data were analyzed by combining data extracted from one hospital, data of the National Health Insurance Service, and the National Statistical Office mortality data. The rationale for utilizing an integrated data set was that a single dataset from a single hospital was insufficient for comprehending economic factors, mortality rates, and medical information.

Results: The analysis yielded two principal conclusions. Firstly, concurrent administration of psychiatric therapy and anti-craving prescriptions was demonstrated to be an effective approach in the management of alcohol-related disorders. Secondly, the economic status of patients was found to influence outcomes of psychiatric pharmacotherapy.

Conclusion: The integration of diverse alcohol-related data for management could facilitate the implementation of personalized prescriptions tailored to specific needs of each patient. This approach has the potential to reduce mortality rates and mitigate societal burdens associated with alcohol-related diseases.

Objective: This study aimed to examine the predictive validity of the revised Suicide Crisis Inventory (SCI-2) and determine its optimal cutoff score.

Methods: Data from 662 community adults participating in a one-year follow-up study were analyzed. Receiver operating characteristic analysis was conducted to examine whether the SCI-2 could predict suicide attempts and ideation with intent at the follow-up and to determine the optimal cutoff score for identifying individuals at high risk for suicide.

Results: The SCI-2 demonstrated adequate predictive validity for suicide attempts and ideation with intent at the one-year follow-up. Based on Youden's index and Runeson et al.'s criteria, a cutoff score of 102 was proposed as the threshold for high-risk groups.

Conclusion: The SCI-2, a measure of Suicide Crisis Syndrome, demonstrated predictive validity using longitudinal data. It is effective in identifying high-risk individuals in a community population. These findings highlight the SCI-2 as a valuable tool for early suicide risk detection and prevention.

Objective: Despite an increase in the depressive disorders burden during the coronavirus disease-2019 (COVID-19) pandemic, research remains insufficient. This study aims to advance the understanding of the global depressive disorders burden, focusing on the COVID-19 pandemic.

Methods: Global and regional estimates of incidence, prevalence, and disability-adjusted life years (DALYs) for depressive disorders from 1990 to 2021 were analyzed using the Global Burden of Disease Study 2021. Depressive disorders were defined as the aggregate of major depressive disorder and dysthymia. Estimates were stratified by age, sex, Socio-demographic Index (SDI), and region, and trends were assessed by annual percent change. Attributable risk factors and projections to 2050 were assessed by modeling risk factors.

Results: In 2021, depressive disorders accounted for 56,330.36 (95% uncertainty interval [UI], 39,339.99 to 76,538.17) DALYs. The age-standardized DALYs rate (ASDR) remained stable until 2019, followed by an increase during the COVID-19 pandemic (ASDR in 1990: 600.51 [95% UI, 420.94 to 818.45] per 100,000; in 2019: 593.50 [413.34 to 810.07]; in 2021: 681.14 [475.19 to 923.83]). The highest ASDRs were observed in low (837.53 [95% UI, 569.85 to 1,140.07] per 100,000) and low-middle (784.07 [542.47 to 1,059.21]) SDI regions. The burden increased rapidly among adolescents and remained higher in females than in males. The burden attributable to intimate partner violence increased during the COVID-19 pandemic. Projections suggest a modest decline in global ASDR, reaching 622.30 (95% UI, 430.96 to 847.82) per 100,000 by 2050.

Conclusion: The global burden of depressive disorders increased sharply during the COVID-19 pandemic. It is essential to address regional disparities in mental health care and promote access to tailored treatment.