Psychiatry Investigation最新文献

Objective: Depression is a prevalent psychiatric disorder posing significant global public health challenges. Although traditional antidepressants are widely used, their full therapeutic effects typically require prolonged administration, which may compromise patient outcomes. To enhance treatment efficacy and patient well-being, identifying rapidly acting and safe therapeutic agents is critical. Oxytocin, an endocrine polypeptide hormone, has shown therapeutic potential in depression by modulating physiological, cognitive, and social behaviors via central and peripheral mechanisms.

Methods: This review was conducted using the PubMed and Web of Science databases without time restrictions. It provides the first systematic synthesis of empirical evidence on the oxytocin's therapeutic efficacy across depressive disorders, comprehensively describes its potential neurobiological targets, and rigorously evaluates its therapeutic mechanisms. Data from randomized controlled trials were analyzed to assess the clinical feasibility and scientific validity of oxytocin.

Results: Evidence from included studies suggested that oxytocin enhanced maternal perception of infants in females with postpartum depression, although its impact on maternal mood was inconsistent. Oxytocin demonstrated efficacy as an adjunctive therapy to psychotherapy or pharmacotherapy in major depressive disorder and treatment-resistant depression. Additionally, studies identified sex differences in oxytocin's antidepressant effects.

Conclusion: The present study provides a comprehensive summary of oxytocin's antidepressant effects, offers new insights into its use for treating diverse subtypes of depression, and presents useful guidance for developing evidence-based depression treatment protocols.

Objective: Zolpidem is widely prescribed to psychiatric outpatients for the management of insomnia due to its rapid and potent efficacy. However, concerns persist regarding its potential association with suicidal tendencies. While studies have suggested that Z-drugs may influence suicidal behavior in the general population, the specific association of Z-drug use and suicide risk in psychiatric outpatients with insomnia remains unclear. This study aims to investigate the association of zolpidem use and suicidal tendencies in this population.

Methods: This retrospective study analyzed the medical records of psychiatric outpatients who visited a mental health clinic between January 2018 and December 2022. Of the 6,193 patients assessed, 3,128 (average age: 49.4 years; 36.6% male) reported insomnia, and 364 (11.6%) were prescribed zolpidem. Suicidal tendencies including past suicide attempts, current suicidal ideation, and plans were evaluated in relation to zolpidem use.

Results: Psychiatric outpatients with insomnia who used zolpidem demonstrated significantly higher rates of suicidal tendencies (χ2=3.97, p=0.046) and suicide attempts (χ2=8.12, p=0.004, 23.6% in zolpidem users) compared to non-users. Logistic regression analysis revealed that zolpidem use was significantly associated with increased suicidal tendencies (β=0.314, standard error=0.137, odds ratio= 1.368, 95% confidence interval [CI] 1.05-1.79, p=0.022), suicidal ideation (β=0.326, standard error=0.138, odds ratio=1.386, 95% CI 1.06-1.82, p=0.018), and suicide attempts (β=0.379, standard error=0.157, odds ratio=1.460, 95% CI 1.07-1.98, p=0.016), even after adjusting for relevant clinical factors.

Conclusion: This study highlights a significant association of zolpidem use and elevated suicidal tendencies among psychiatric outpatients with insomnia. Although a causal relationship cannot be definitively established, these findings highlight the critical importance of thorough suicide risk assessment and ongoing monitoring in patients prescribed zolpidem.

Objective: The visual system plays a crucial role in regulating sleep by providing cues that synchronize the circadian rhythm. Consequently, ophthalmic diseases-particularly diabetic retinopathy (DMR), age-related macular degeneration (AMD), epiretinal membrane (EM), and glaucoma-may influence sleep duration through circadian disruption and disease-related psychological stress. However, large-scale studies examining the relationship between these conditions and sleep duration remain limited. This study investigated these associations in a nationwide, population-based sample.

Methods: This cross-sectional study analyzed data from the 2019 and 2020 the Korea National Health and Nutrition Examination Survey. Ophthalmic diseases were diagnosed through fundoscopy, and sleep duration on weekdays and weekends was self-reported. The study included 8,395 participants aged 40 years or older who underwent fundoscopy. Statistical models were adjusted for demographic and clinical covariates, including age, sex, body mass index, and comorbidities.

Results: Patients with DMR and EM had significantly reduced sleep duration, with reductions of 0.3 hours to 0.5 hours on weekdays and weekends compared to individuals without these conditions. No significant differences in sleep duration were observed for AMD or glaucoma. After covariate adjustment, the associations between shorter sleep duration and DMR or EM remained significant.

Conclusion: This nationwide population-based study using fundus photography revealed that DMR and EM are significantly associated with reduced sleep duration, while AMD and glaucoma are not. These findings suggest a differential sleep impact by disease type and support the need for targeted evaluation and management of sleep in patients with ophthalmic diseases. Further research is warranted to clarify underlying mechanisms and guide public health strategies.

Objective: Sexting has been linked to negative mental health outcomes. This Taiwan-based study addresses the links between sexting, cyberbullying, self-harm, and gender differences in the association of sexting and self-harm behavior.

Methods: A two-stage stratified sampling of 5,190 Taiwanese adolescents aged 11-18 completed an online questionnaire measuring sexting, bullying/cyberbullying, and self-harm. Two-way interaction model was used to identify the effect of gender on the relationship between sexting and self-harm behavior. The relationship between sexting and self-harm risk was tested in both the total sample and in different gender groups using univariable and multivariable linear regression models.

Results: 2.5% of adolescents engaged in some form of sexting in the past year. 1.7% had sent their own picture or video. 1.0% had experienced non-consensual sexting, and 0.9% had sexted under pressure. Female gender, sexting one's own information, non-consensual sexting, and pressured sexting were associated with higher self-harm scores.

Conclusion: This is the first study to focus on gender differences in the association between different types of sexting and self-harm in a non-Western society. The impact of sexting on self-harm was found to differ between males and females. Different types of sexting may also be associated with different risks of self-harm.

Objective: Self-harm and online aggressive behavior, recognized as dual-harm behaviors, have become increasingly prevalent among college students, which is strongly related to social anxiety. Yet, the underlying mechanism remains unclear and social network sites (SNS) addictive tendency may have a mediating effect. In addition, the influence of sex requires further clarification.

Methods: A convenient sampling method was employed and 1,608 college students (females=1,245, 77.43%; Meanage=18.95 years) were recruited. Scales measuring social anxiety, online aggressive behavior, self-harm behavior, and SNS addictive tendency were utilized. Structural equation modelling based on Mplus was conducted to testify the mediating effect of SNS addictive tendency and Wald's χ2 test was employed to clarify sex difference.

Results: Social anxiety is significantly and positively related to online aggressive behavior, self-harm behavior, and SNS addictive tendency. The mediating effect of SNS addictive tendency is tested to be significant (online aggressive behavior: β=0.13, 95% confidence intervals [CIs], 0.077-0.191; self-harm behavior: β=0.05, 95% CIs, 0.000-0.104) and sex could moderate the effect of social anxiety on SNS addictive tendency. The relation between social anxiety and SNS addictive tendency is significantly stronger among males.

Conclusion: The current study suggests that social anxiety could cause a higher risk of both online aggressive and self-harm behavior through SNS addictive tendency, especially among male college students. Therefore, further interventions should target assisting college students to develop interpersonal relations in the real world could be beneficial.

Objective: This study aimed to clarify how chronic diseases (CDs) contribute to depression and suicidal ideation (SI) prediction using machine learning (ML) techniques among the older adult population.

Methods: National representative data of 5,419 older adults from the Korea National Health and Nutrition Examination Survey conducted in 2013, 2015, 2017, and 2019 were used in this study. The number and type of CDs were incorporated into Models 1 and 2, respectively, using five ML methods.

Results: The average age of the participants was 72.7 years, with 43.2% males, 15.2% reporting depression, and 7.3% reporting SI. The number of CDs was correlated with increased depression and SI. The ML models showed moderate-to-good performance in the prediction of depression and SI. The area under the curve (AUC) values for Model 1 ranged from 0.729 to 0.772 for depression, and from 0.754 to 0.793 for SI. In Model 2, the AUC ranged from 0.704 to 0.768 for depression and from 0.750 to 0.785 for SI. More depression and SI were expected when the number of CDs was one or more and two or more, respectively. The top predictors of depression were osteoarthritis, myocardial infarction, diabetes, asthma, and stroke, whereas those predicting SI were stroke, hypertension, asthma, myocardial infarction, and rheumatoid arthritis.

Conclusion: The number and specific types of CDs predicted depression and SI among Korean older adults. These results may help enhance cooperation with clinicians treating CDs and promote the early detection and prevention of further SI and behaviors.

Objective: To investigate the correlation between appendicular skeletal muscle mass (ASM)/height (ASMIht), ASM/body mass index (ASMIBMI), ASM/weight (ASMIwt), and ASM/waist circumference (ASMIwc) and cognitive function among inpatients with stable schizophrenia.

Methods: This was a cross-sectional study of 235 stable schizophrenia inpatients, including 60% males (n=141). Patient demographic information and body composition data were collected. The Montreal Cognitive Assessment-Chinese version (MoCA-C) was used to measure cognitive function. To determine the association between the muscle mass indices and cognitive function, multiple linear regressions were established.

Results: The median age of males and females were 51 years (range 42-55) and 51 (range 39-58), respectively. Spearman's correlation analysis revealed a significant association between ASMIwc and the MoCA-C scores (r=0.323, false discovery rate [FDR]=0.004) in males, while ASMIBMI, ASMIwt, and ASMIwc (r=0.268-0.421, all FDR <0.05) were significantly correlated with MoCA-C scores in females. Furthermore, covariate-adjusted multiple linear regression analysis further confirmed that only the ASMIwc was related to MoCAC scores after controlling for relevant variables (males: β=0.565, 95% confidence interval [CI], 0.156-0.974, p=0.007; females: β=0.96, 95% CI, 0.394-1.526, p=0.001).

Conclusion: Our findings showed a substantial correlation between the ASMIwc and cognitive function in schizophrenia inpatients. Further validation of these data in broader study populations is now necessary.

Objective: Weekend catch-up sleep (CUS) has been associated with certain health benefits; however, there is a paucity of research regarding the correlation between CUS and depression in adults. This study aimed to investigate the association between weekend CUS and depressive symptoms in a nationally representative adult population.

Methods: We analyzed data from the 2017-2018 National Health and Nutrition Examination Survey. Depression was assessed using the Patient Health Questionnaire-9, with a score ≥10 indicating clinically significant depressive symptoms. CUS duration was categorized into four groups: CUS≤0 h, 0 h2 h. Multivariable logistic regression models adjusted for sociodemographic factors, health behaviors, and comorbidities were employed to examine associations.

Results: Out of 4,450 eligible participants, 2,169 (48.7%), 943 (21.2%), 641 (14.4%), and 697 (15.7%) had weekend CUS durations of ≤0, 0 to 1, 1 to 2, and >2 h, respectively. The prevalence of depression was found to be 9.59%, 7.74%, 7.18%, and 8.75%, respectively, in these groups. Adjusted for multiple variables, the odds ratios (ORs) for depression were 0.89 (95% confidence interval [CI] 0.54-1.48), 0.71 (95% CI 0.37-1.37), and 0.97 (95% CI 0.57-1.65) for individuals with 0 h2 h, respectively, in comparison to those with CUS≤0 h. However, subgroup analyses suggested a potential protective effect of CUS (>2 h) against depression in individuals with weekday sleep duration <6 h (OR=0.47, 95% CI 0.27-0.83).

Conclusion: Weekend CUS was not associated with depression risk in the general adult population. The observed protective effect in sleep-restricted individuals warrants further investigation through prospective studies to evaluate potential causal relationships.

Objective: We developed a Korean-language version of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ) and then assessed its reliability and validity among the general population by comparing its results with those of preexisting questionnaires regarding sleep-related cognition.

Methods: The study participants (n=300) completed the newly translated APSQ as well as Korean versions of the Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16) Scale, Metacognitions Questionnaire-Insomnia-14 items (MCQI-14), Glasgow Sleep Effort Scale (GSES), and Insomnia Severity Index (ISI) through an online platform accessible from 17-27 July 2023. A confirmatory factor analysis of the APSQ revealed good fits for both the full-scale and two-factor models, consistent with the original version.

Results: The Korean version of the APSQ also demonstrated good internal consistency, showing Cronbach's alpha values of 0.965 for the full scale, 0.954 for factor I, and 0.928 for factor II. In addition, the full-scale APSQ and both subscales demonstrated good convergent validity with ISI, DBAS-16, MCQI-14, and GSES as evidenced by strong correlations between the corresponding scores. The scale information curves further revealed that the APSQ provided more information on the latent trait (worry regarding sleep) than the other sleep measures.

Conclusion: The APSQ scale and its two subscales are valid tools for measuring sleep-related worry among the general South Korean population. Additional studies of specific clinical groups are required to confirm the scope of its applicability and utility for the treatment of insomnia.

Objective: This study develops an eXtreme Gradient Boosting (XGBoost) regression model to identify key predictors of mortality and 5-year survival in dementia patients, highlighting the role of comorbidities. The findings highlight key risk factors that may facilitate targeted adjustments in clinical care and resource allocation for high-risk patients.

Methods: We used Taiwan's National Health Insurance dataset to develop and validate an XGBoost model predicting 5-year survival in dementia patients aged 65 years or older. The cohort (n=6,556) was split into 80% for training, 10% for validation, and 10% for testing. A total of 24 variables, including comorbidities and demographic factors, were selected as predictors. Hyperparameters were tuned to optimize performance, with a learning rate of 0.1, 1,000 estimators, and a maximum depth of 10. Regularization techniques were applied to prevent overfitting.

Results: The XGBoost model achieved 81.86% accuracy in predicting 5-year survival, with a receiver operating characteristic area under the curve of 0.81 and a log loss of 0.61. Of the 37 initial features, 24 were included, and the top 10 predictors were nasogastric tube insertion, chronic kidney disease, cancer, lung disease, urinary tract infection, fracture, peripheral vascular disease, antidepressant use, hypertension, and upper gastrointestinal issues.

Conclusion: The XGBoost model effectively predicts 5-year survival in dementia patients, identifying key predictors that can guide targeted care, preventive strategies, and healthcare resource planning.