The primary care companion for CNS disorders最新文献

Introduction: Mental health of health care workers (HCWs) was affected during the COVID-19 pandemic due to direct handling of suspected and confirmed cases. While neurobiological mechanisms that mediate stress, depression, and anxiety are well established, psychological mechanisms are not.

Objective: To assess (1) the prevalence of anxiety, depression, insomnia, and perceived stress among accredited social health activists, multipurpose health workers, auxiliary nurse midwives, and other certified HCWs of rural areas of Telangana, India and (2) the factors that mediate stress with depression and anxiety.

Methods: A total of 300 HCWs from across 10 primary health centers across 5 districts were selected. All participants self-reported their anxiety, depression, sleep problems, and perceived stress related to the pandemic. Sociodemographic and other relevant data pertinent to the context of stress and the pandemic were also obtained. The survey used translated and validated self report instruments and was conducted during August and September 2021.

Results: The mean (SD) scores on the Insomnia Severity Index, 7-item Generalized Anxiety Disorder scale, Pandemic-Related Perceived Stress Scale of COVID-19, and 9-item Patient Health Questionnaire were 5.94 (5.6), 4.21 (4.5), 21.94 (5.8), and 3.89 (4.8), respectively. Age <35 years and family members being COVID-19 positive were significant predictors of depression and anxiety, respectively. Greater number of family members and COVID-19-positive status were significant predictors of insomnia. While the effect of stress on anxiety was indirect through the mediation of insomnia and depression, the effect of stress on depression was direct as well as through the mediation of anxiety.

Conclusion: The study results highlight the importance of measures to address sleep-related issues in individuals who are experiencing psychosocial stressors to prevent the development of depression and anxiety.

Prim Care Companion CNS Disord 2025;27(1):24m03723.

Author affiliations are listed at the end of this article.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Prim Care Companion CNS Disord 2025;27(1):24f03793.

Author affiliations are listed at the end of this article.

Objective: Insomnia and some insomnia treatments can impact an individual's daytime functioning. Here, we performed post hoc analyses of patient-reported outcomes from a phase 3 clinical trial to assess the impact of lemborexant (LEM), a dual orexin receptor antagonist, on daytime functioning.

Methods: Adults with insomnia were randomized 1:1:1 to receive placebo, LEM 5 mg (LEM5) or LEM 10 mg (LEM10) for 6 months. Treatment impact on subjects' perceptions of their insomnia symptoms and daytime functioning was assessed by the Insomnia Severity Index (ISI) and Fatigue Severity Scale (FSS) questionnaires. Safety assessments included monitoring of treatment emergent adverse events.

Results: Compared with placebo, LEM5 and LEM10 treatment significantly improved ISI Total Score (ISI-TS) (LEM5, P < .01; LEM10, P < .0001) and ISI Daytime Functioning Score (ISI-DFS) (LEM5, P < .05; LEM10, P < .01) at 1 month; these improvements were maintained at the end of 6 months (P < .0001 for LEM5 and LEM10, both scores). In separate analyses, baseline ISI-TS or ISI-DFS was used to classify subjects' symptom severity into 1 of 4 categories. At 1 and 6 months, greater proportions of subjects treated with LEM5 and LEM10 shifted to a category associated with less severe symptoms (P < .01 for all comparisons vs placebo). FSS score also improved with LEM treatment vs placebo as assessed at month 3; improvements were maintained at month 6 (P < .05). LEM5 and LEM10 treatment was well tolerated.

Conclusion: Improved insomnia symptoms with LEM treatment may translate into improved daytime functioning, suggesting LEM may be appropriate for adults experiencing daytime impairment with their nighttime symptoms.

Trial Registration: ClinicalTrials.gov identifier: NCT02952820.

Prim Care Companion CNS Disord 2025;27(1):24m03810.

Author affiliations are listed at the end of this article.

Objective: US military veterans are at elevated risk for suicide. High levels of suicide-specific cognitions, an indicator of chronic suicide risk, have been found to predict suicidal behaviors. The objective of this study was to examine data from a large, nationally representative sample of US veterans to determine the prevalence and correlates of high chronic suicide risk, with the goal of providing population-level insight into veterans who may be most at risk.

Methods: This study utilized data from the 2019-2022 National Health and Resilience in Veterans Study, a nationally representative sample (N = 2,430), to determine the prevalence of veterans who screened positive for high chronic risk for suicide based on the Brief Suicide Cognitions Scale. The relative importance of sociodemographic, military, health, and psychosocial characteristics associated with high chronic risk was also examined.

Results: In total, 250 veterans screened positive for high chronic suicide risk. Analyses revealed that veterans at high risk were lower educated and more likely to report suicidal ideation and disability in activities of daily living. They also endorsed a higher number of adverse childhood experiences and scored lower on measures of protective psychosocial characteristics and social connectedness. Relative importance analyses revealed that lower levels of perceived resilience, social support, and purpose in life accounted for the majority of the explained variance in high chronic suicide risk.

Conclusions: Results suggest that interventions to bolster these positive psychological traits may help reduce suicide risk and death by suicide in veterans.

Prim Care Companion CNS Disord 2025;27(1):24m03821.

Author affiliations are listed at the end of this article.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Prim Care Companion CNS Disord 2025;27(1):24f03813.

Author affiliations are listed at the end of this article.