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Trends, advances and directions in cognitive-behavioral therapy for adolescent anxiety 认知行为疗法治疗青少年焦虑症的趋势、进展和方向

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2024-09-16 DOI: 10.1002/wps.21247

Philip C. Kendall, Marisa Meyer, Julia S. Ney

Adolescence is a time of dramatic change in physical, behavioral, emotional, cognitive and social domains, and the context in which one matures plays a crucial role. The early 2020s provided a unique context for adolescent development, filled with unprecedented events across multiple levels of life. These contextual forces potentially impacted what we know from previously studied developmental trajectories during adolescence.Here we briefly highlight recent research on adolescent anxiety associated with social media use and the COVID-19 pandemic, and focus on the latest trends and advances in cognitive-behavioral therapy (CBT) for treating anxiety in youth. We emphasize the importance of behavioral exposure tasks and the necessity of “flexibility within fidelity”1 in manual-based CBT interventions. Lastly, we identify future research directions for evaluating the development, maintenance and treatment of anxiety in adolescents.Rates of anxiety among youth – as well as depression, suicidality, and other mental health conditions – have increased in recent years. Specifically, anxiety symptoms increased during the COVID-19 pandemic, with 20% of surveyed youth experiencing these symptoms, compared to 11% before the pandemic2. Further, across all socioeconomic levels, about 70% of adolescents reported believing that anxiety and depression are major problems among people of their age in their community3. Widening disparities in anxiety prevalence have been noted among girls relative to boys, and among sexual minority youth compared to heterosexual ones2, 4.Adolescents currently face stressors that may contribute to increases in anxiety. The COVID-19 pandemic took a toll on youth psychological well-being, including disrupted milestones, loss of peer interactions, and social isolation2. Adolescents are heavy consumers of digital technology and social media: this has the potential to provide benefits to youth through opportunities to strengthen social relationships. However, social media may also lead to an increase in anxiety symptoms. In a longitudinal study of adolescents aged 12-15, those spending more than three hours per day on social media were prospectively more likely to experience internalizing problems (i.e., anxiety and depression5). It is not a stretch to see the double-edged features of heavy adolescent social media use.Recent research continues to bolster the large body of existing evidence demonstrating the efficacy6 and effectiveness7 of CBT in treating adolescent anxiety, with the latest studies parsing treatment effects according to intervention modality and emphasis on key components (e.g., psychoeducation, cognitive restructuring, exposure tasks). When comparing CBT modalities to waitlist controls based on anxie

实施 CBT 的潜在环境也需要灵活性：它们可以包括学校、社区心理健康中心、远程医疗和基于计算的平台，以及居家治疗。经验支持的治疗方法的主要特征仍然是必需的，但其特征可以根据实际可行的实施需求而有所不同。相对于标准的面对面治疗，以数字设备为媒介的 CBT（由 COVID-19 大流行带来）的增加突出了灵活的调整策略和机会。例如，利用 Facetime 或笔记本电脑摄像头，暴露任务可以在青少年的真实环境中进行，并在治疗师的支持下进行1。远程医疗平台使跨地域的 CBT 干预更容易实现，使青少年既能与同伴一起进行暴露，又能与其他有类似心理健康问题的人建立联系。未来，人们可能会越来越关注青少年焦虑症治疗中面对面治疗与远程医疗的比较。同样，供青少年在克服焦虑症时使用的应用程序不仅会更加普及，而且还需要进行适当的评估。我们并不认为人工智能会取代 CBT 服务提供者，但我们确实看到远程医疗的存在和影响会越来越大。然而，我们知道，改善的意义远不止症状的减轻。未来的研究将受益于对自我效能感的提高以及在掌握个人焦虑情况方面的特异性收获的研究。针对青少年对保证的需求和/或改善其社会交往的治疗方法很可能会加强目前的方法。目前，服务提供者会 "随机应变"，根据患者的情况调整自己的工作。通过机器学习，我们可以识别焦虑青少年的特征，他们将对治疗的各个组成部分做出反应。换句话说，将机器学习的研究结果应用于大型、同质化的数据集，可以告知服务提供者，针对特定客户的特点，哪些调整可能会达到最佳效果。因此，CBT 目前已被确立为治疗青少年焦虑症的一线疗法，但个性化和增强这种经验支持疗法的努力很可能会在未来推广开来，并对临床实践产生重大影响。

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引用次数: 0

The problem with borderline personality disorder 边缘型人格障碍的问题

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2024-09-16 DOI: 10.1002/wps.21249

Peter J. Tyrer, Roger T. Mulder

In the late 1980s, the ICD-10 Working Party on Personality Disorders had little evidence on which to base its decisions and, understandably, followed the lead of the DSM, with its well-funded and popular third and subsequent editions.When the Working Party came to the sensitive subject of individual personality disorders, it found that the evidence for “borderline personality disorder” was insufficient for it to be included. But a lobby of supporters did not allow this, and eventually two extra personality disorder groupings were included under the heading of “emotionally unstable personality disorder” (F60.3) – an “impulsive type” (F60.30), characterized by a “tendency to act unexpectedly” and to show “quarrelsome behaviour” and an “unstable and capricious mood”; and a “borderline type” (F60.31), characterized by uncertain self-image, unstable relationships, efforts to avoid abandonment, and recurrent self-harm.We have yet to see much evidence that the impulsive type (F60.30) has been used in practice. On the contrary, the borderline type is by far the most commonly used personality disorder diagnosis, so much so that the original splitting of the “emotionally unstable personality disorder” into two groups has been forgotten entirely.In the ICD-11 revision group, more than two decades later, the same conclusion was reached: borderline personality disorder was not considered to be a suitable diagnosis for inclusion and was ignored, as indeed were all other categories of personality disorder in the new dimensional system1. But, as with the ICD-10, the borderline diagnosis was not to be spurned by others. There was general dissatisfaction with its omission2, and a strong appeal for it to be included in some form. Thus, the “borderline pattern specifier” was added as a compromise3.How do we explain that, after two revision groups decided to exclude this condition as unsatisfactory, borderline personality disorder continues to be supported as a diagnosis? The standard explanations are that it is useful in clinical practice, is widely used, and gives options for treatment, unlike other personality disorders. However, the same could be said, almost exactly, of the diagnosis of neurasthenia between 1870 and 1990 (it appeared apologetically in the ICD-10), which has now been recognized to be redundant, as it was vaguely defined, was so prevalent that it lacked discrimination, and became toxic through criticism and stigma.These same concerns apply to borderline personality disorder. It is like a large bubble wrap over all personality disorders, easily recognized on the surface but obscuring the disorders that lie beneath. Personality abnormality is identifiable through traits that are persistent, exactly as normal personality traits. The features of borderline personality disorder are not traits, but symptoms and fluctuating behaviours<

这种说法的问题在于，该术语是污名化的一个主要来源。被认定为边缘型人格障碍的患者，即使其行为与其他未被贴上这一标签的患者相同，也会被认为更难管理9。接受其他精神疾病（如注意力缺陷/多动障碍、药物使用障碍或情绪障碍）以及躯体疾病的治疗也会变得更加困难。边缘型人格障碍的标签贬低了所有其他症状的价值，使其更容易被忽视。我们认为，解决办法是放弃边缘型人格障碍诊断，代之以一种更透明的人格病理学描述系统。由于边缘型人格障碍的诊断与中度至重度人格障碍的整体诊断高度相关，因此评估患者功能障碍的严重程度是第一步。许多中度或重度人格障碍患者都会有现在被称为 "边缘型 "的特征，如情绪失调、人际关系过敏和冲动行为，但并非所有人都如此。有些人会有突出的社交和情感疏离，有些人会有完美主义和固执己见，或自我中心和缺乏同情心。新的 ICD-11 人格障碍分类法允许进行更广泛的评估。严重程度的维度分类--分为人格困难和轻度、中度和重度人格障碍--意味着鼓励临床医生在关注具体症状和行为之前先评估整体严重程度。五个领域（负性情感、疏离、非社会性、抑制和厌世）类似于正常人格中的五大领域，可以对这些症状和行为进行更细致的描述，超出了边缘型人格障碍所包含的范围，尤其是疏离和厌世领域。一个复杂的治疗方案有望带来一系列干预措施，而不是对每个人都采取标准的治疗方案。总之，边缘型人格障碍最好被视为一种过渡性诊断，它引起了人们对中重度人格障碍患者的关注，并鼓励对结构化心理疗法进行测试。然而，现在人们发现，这一诊断与特定的人格特质无关，过度包容，除了结构化的临床护理外，并不能带来特定的治疗方法。边缘型人格障碍在这一领域的主导地位意味着对其他人格病理学的评估和治疗受到阻碍，人格功能障碍的整个概念被污名化。现在是边缘型人格障碍躺下等死的时候了。

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引用次数: 0

Impact of pre-trauma recreational drug use on mental health outcomes among survivors of the Israeli Nova Festival terrorist attack 以色列新星音乐节恐怖袭击幸存者创伤前使用娱乐性药物对心理健康结果的影响

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2024-09-16 DOI: 10.1002/wps.21254

Nitsa Nacasch, Tal Malka, Joseph Zohar, Yarden V. Dejorno, Gal Levi, Raz Gross, Mark Weiser, Hagit Cohen

On October 7, 2023, about 4,000 civilians attending the Nova open-air music festival in southern Israel were the victims of a sudden terrorist attack. They had to swiftly react to the attack by running and hiding for extended periods of time to protect their lives.At the time of the attack, a significant proportion of these people were under the influence of various recreational drugs. We hypothesized that the pre-trauma use of psychostimulants or hallucinogens would be significantly associated with the severity of peri-traumatic dissociation, anxiety, depression, and acute stress disorder (ASD) symptoms in survivors of the attack.Two hundred thirty-two survivors sought assistance at the Chaim Sheba Medical Center and underwent clinical evaluation. They were considered for this study if they had no severe physical injuries; no first-degree family member killed during the attack; and no history of mental disorders, including post-traumatic stress disorder (PTSD).Of the 232 survivors screened for the study, 126 met the above criteria and provided informed consent to participate. However, two of them who reported using hallucinogenic mushrooms, and one who reported using ketamine prior to the traumatic event, were excluded from the analysis, due to the small sample size for these drugs, leaving a sample of 123 participants. Their mean age (±SE) was 28.4±0.7 years; 75 of them (60.9%) were male; 68.9% were never married, and 68.2% were holding a high-school degree or equivalent.Seventy-one of them (57.7%) reported using psychoactive drugs at the festival – 12 only alcohol, nine only lysergic acid (LSD), seven only 3,4-methylenedioxymethamphetamine (MDMA), six only cannabis, three only methylmethcathinone (MMC), 15 various drug combinations including alcohol, and 19 various drug combinations excluding alcohol.All participants completed several questionnaires, assessing peri-traumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire, PDEQ), post-traumatic anxiety (Generalized Anxiety Disorder-7, GAD-7; and Visual Analog Scale for Anxiety, VAS-A), depression (Patient Health Questionnaire-9, PHQ-9), and ASD symptoms (Posttraumatic Diagnostic Scale, PDS-5).Both the GAD-7 scores and the PDS-5 hyperarousal scores were significantly higher in the drug-user than in the drug-free group (p<0.05 and p<0.008, respectively). The scores of most participants were above the clinical threshold for these instruments (>10 for GAD-7 in 70.4%, and >28 for PDS-5 in 81.3% of the participants), indicating a very high level of anxiety- and hyperarousal-related symptoms in both groups. Both the PDEQ and PHQ-9 scores were higher in the drug-user than in the drug-free group, but the differences were not significant. No significant differences were found between the groups in the VAS-A, total PDS-5, and PDS-5 subscales. The VAS-A scores of 51.9% of the participants were higher than 6, which is the cli

2023 年 10 月 7 日，约 4000 名参加以色列南部诺瓦露天音乐节的平民成为一场突如其来的恐怖袭击的受害者。在袭击发生时，这些人中有相当一部分受到了各种娱乐性药物的影响。我们假设，创伤前使用精神兴奋剂或致幻剂与袭击幸存者创伤前分离、焦虑、抑郁和急性应激障碍（ASD）症状的严重程度有显著关联。在经过筛选的 232 名幸存者中，有 126 人符合上述标准，并在知情的情况下同意参与研究。然而，其中有两名幸存者表示在创伤事件发生前曾使用致幻蘑菇，一名幸存者表示在创伤事件发生前曾使用氯胺酮，由于这些药物的样本量较小，因此被排除在分析之外。他们的平均年龄（±SE）为 28.4±0.7 岁；其中 75 人（60.9%）为男性；68.9% 的人从未结过婚，68.2% 的人拥有高中或同等学历。他们中有 71 人（57.7%）称在音乐节上使用了精神药物--12 人只饮酒，9 人只服用麦角酸（LSD），7 人只服用 3,4-亚甲二氧基甲基苯丙胺（MDMA），6 人只服用大麻，3 人只服用甲卡西酮（MMC），15 人服用包括酒精在内的各种混合药物，19 人服用不包括酒精在内的各种混合药物。所有参与者都填写了几份问卷，评估创伤前分离体验（创伤前分离体验问卷，PDEQ）、创伤后焦虑（广泛性焦虑症-7，GAD-7；焦虑视觉模拟量表，VAS-A）、抑郁（患者健康问卷-9，PHQ-9）和 ASD 症状（创伤后诊断量表，PDS-5）。用药组的 GAD-7 评分和 PDS-5 过度焦虑评分均显著高于未用药组（分别为 p<0.05 和 p<0.008）。大多数参与者的得分都高于这些工具的临床阈值（70.4% 的参与者 GAD-7 得分为 10，81.3% 的参与者 PDS-5 得分为 28），这表明两组参与者的焦虑和过度焦虑相关症状都非常严重。吸毒者组的 PDEQ 和 PHQ-9 分数均高于未吸毒者组，但差异不显著。在 VAS-A、PDS-5 总分和 PDS-5 分量表方面，两组之间没有发现明显差异。51.9%的参与者的VAS-A得分高于6分，这是该工具的临床阈值。对PDEQ、PHQ-9、GAD-7、PDS-5（总分和分量表）和VAS-A问卷的得分进行了多元回归分析，采用了九组与吸毒、性别和年龄相关的自变量（见补充信息）。创伤前解离的严重程度与事件发生前的饮酒量有显著相关性（β=0.25，p<0.008），但与其他任何药物的消费无关。与服用其他药物相比，在创伤事件发生前饮酒会明显增加创伤前解离的可能性（PDEQ 分数 = 24.8±2.0 vs. 19.3±1.0，p<0.015）。PHQ-9 分数模型具有统计学意义（p=0.02）。抑郁症状的严重程度与事件发生前的饮酒量显著相关（β=0.32，p<0.001），但与其他任何药物的摄入量无关。与服用其他药物相比，事件发生前饮酒会明显增加出现抑郁症状的可能性（PHQ-9 评分 = 18.7±1.8 vs. 13.8±0.6，p<0.0015）。焦虑症状的严重程度与事件发生前的饮酒量明显相关（β=0.29，p<0.002）。与活动前服用其他药物相比，活动前饮酒会明显增加焦虑的可能性（GAD-7 评分 = 16.3±1.0 vs. 12.7±0.6，p<0.004）。事件发生前服用的其他药物均未对焦虑症状产生明显影响。PDS-5唤醒-过度活跃评分模型具有统计学意义（p=0.03）。唤醒和多动症状的严重程度与创伤事件前的酒精摄入量（β=0.24，p<0.011）和 MMC 摄入量（β=0.24，p<0.011）明显相关。

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引用次数: 0

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications 社会联系是身心健康的关键因素：证据、趋势、挑战和未来影响

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2024-09-16 DOI: 10.1002/wps.21224

Julianne Holt-Lunstad

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

全球范围内对社会隔离和孤独感的关注与日俱增，这凸显了人们需要更深入地了解它们对身心健康的影响。大量证据表明，社会联系因素是心理和身体健康的独立预测因素，其中关于死亡率的证据最为有力。尽管大多数数据都是观察性的，但有证据表明了影响的方向性、合理的途径，以及在某些情况下社会联系与日后健康结果之间的因果关系。多项指标显示的社会趋势表明，缺乏社会联系的人越来越多，而且有相当一部分人报告说他们感到孤独。在过去的二十年里，特别是自 2020 年以来，有关社会隔离和孤独的科学研究已大大扩展；然而，公众对其与健康和死亡率的相关性仍然认识不足。尽管证据确凿，但仍存在一些挑战，包括需要一种共同语言来协调各科学学科的不同相关术语，需要一致的多因素测量方法来评估风险，以及需要有效的解决方案来预防和减轻风险。COVID-19 大流行可能带来的长期后果，以及数字技术在社会变革中的作用，都可能导致社会、精神和身体健康的进一步下降，这凸显了未来健康的紧迫性。为了扭转这些趋势和应对这些挑战，我们提出了一些建议，以更全面地弥补我们认识上的差距，促进社会联系，解决社会隔离和孤独问题。

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引用次数: 0

Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. 难治性抑郁症：定义、患病率、检测、管理和研究干预。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21120

Roger S McIntyre, Mohammad Alsuwaidan, Bernhard T Baune, Michael Berk, Koen Demyttenaere, Joseph F Goldberg, Philip Gorwood, Roger Ho, Siegfried Kasper, Sidney H Kennedy, Josefina Ly-Uson, Rodrigo B Mansur, R Hamish McAllister-Williams, James W Murrough, Charles B Nemeroff, Andrew A Nierenberg, Joshua D Rosenblat, Gerard Sanacora, Alan F Schatzberg, Richard Shelton, Stephen M Stahl, Madhukar H Trivedi, Eduard Vieta, Maj Vinberg, Nolan Williams, Allan H Young, Mario Maj

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.

难治性抑郁症（TRD）是常见的，并与多种严重的公共卫生影响有关。目前还不存在对TRD的一致定义，该定义在临床决策和健康结果方面具有显著的预测效用。相反，人们提出了大量的定义，这些定义在概念框架上差异很大。缺乏一致的定义阻碍了对TRD患病率的精确估计，也掩盖了识别风险因素、预防机会和有效干预措施的努力。此外，它还导致临床实践决策的异质性，对护理质量产生不利影响。美国食品药品监督管理局（FDA）和欧洲药品管理局（EMA）采用了最常用的TRD定义（即，尽管治疗试验充分且坚持治疗，但对至少两种抗抑郁药的反应不足）。目前估计，至少有30%的抑郁症患者符合这一定义。相当大比例的TRD患者实际上具有伪耐药性（例如，由于治疗试验不足或不坚持治疗）。尽管已知多种社会人口学、临床、治疗和环境因素会对抑郁症患者的反应产生负面影响，但很少有因素能预测多种治疗方式的无反应。静脉注射氯胺酮和鼻内注射氯胺酮（与抗抑郁药联合给药）被证明对TRD有效。一些第二代抗精神病药物（如阿立哌唑、布瑞哌唑、卡哌嗪、喹硫平XR）被证明是部分应答者抗抑郁药的辅助治疗药物，但只有奥氮平-氟西汀联合用药在美国食品药品监督管理局定义的TRD中进行了研究。重复性经颅磁刺激（TMS）被认为是有效的，并被美国食品药品监督管理局批准用于TRD患者，加速θ脉冲TMS最近也显示出疗效。电休克治疗被认为是TRD的一种有效的急性和维持性干预措施，初步证据表明其对急性静脉注射氯胺酮没有劣效性。延长抗抑郁药试验、药物转换和联合抗抑郁药的证据喜忧参半。基于手动的心理治疗师在TRD中并没有被证明是有效的，但当添加到传统的抗抑郁药中时，可以显著缓解症状。数字疗法正在研究中，代表了这一人群未来潜在的临床前景。

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引用次数: 0

The WPA Expert International Advisory Panel for Early Intervention in Psychosis in Low- and Middle-Income Countries: an update on recent relevant activities. WPA低收入和中等收入国家精神病早期干预专家国际咨询小组：最近相关活动的最新情况。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21130

Swaran P Singh, Afzal Javed, Rangaswamy Thara, Rakesh Chadda, Srividya Iyer, Nikos Stefanis

引用次数: 0

Improving mental health through fostering healthy lifestyles in young people: one of the targets in the WPA Action Plan 2023-2026. 通过培养年轻人的健康生活方式改善心理健康：《2023-2026年WPA行动计划》的目标之一。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21146

Danuta Wasserman, Celso Arango, Andrea Fiorillo, Saul Levin, Andrew Peters, Prasad Rao, Thelma Sanchez-Villanueva, Aida Sylla

引用次数: 0

An update from the WPA Working Group on Digitalization in Mental Health and Care. WPA心理健康和护理数字化工作组的最新消息。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21143

Umberto Volpe, Rodrigo Ramalho, Laura Orsolini, Ramdas Ransing, Renato de Filippis, Ahmet Gürcan, Shreyasta Samal, Wolfgang Gaebel

引用次数: 0

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. 重性抑郁障碍与身体疾病的共病：流行病学、机制和管理的综合综述。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21110

Michael Berk, Ole Köhler-Forsberg, Megan Turner, Brenda W J H Penninx, Anna Wrobel, Joseph Firth, Amy Loughman, Nicola J Reavley, John J McGrath, Natalie C Momen, Oleguer Plana-Ripoll, Adrienne O'Neil, Dan Siskind, Lana J Williams, Andre F Carvalho, Lianne Schmaal, Adam J Walker, Olivia Dean, Ken Walder, Lesley Berk, Seetal Dodd, Alison R Yung, Wolfgang Marx

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

患有常见身体疾病（如心血管疾病、癌症和神经退行性疾病）的人群患重度抑郁症（MDD）的比率明显高于普通人群。另一方面，MDD患者患许多身体疾病的风险更大。这种高水平的合并症与更糟糕的结果、对治疗的依从性降低、死亡率增加以及更高的医疗利用率和成本有关。合并症还可能导致一系列临床挑战，如更复杂的治疗联盟、与适应性健康行为有关的问题、药物相互作用以及用于治疗身心障碍的药物引发的不良事件。上述合并症高患病率的潜在解释涉及共同的遗传和生物学途径。后者包括炎症、肠道微生物组、线粒体功能和能量代谢、下丘脑-垂体-肾上腺轴失调以及大脑结构和功能。此外，MDD和身体疾病有几个共同的前因，这些前因与社会因素（如社会经济地位）、生活方式变量（如体育活动、饮食、睡眠）和压力生活事件（如儿童创伤）有关。药物疗法和心理治疗师是治疗共病MDD的有效方法，生活方式干预以及协作护理模式和数字技术的引入为改善管理提供了有前景的策略。本文旨在提供MDD和特定身体疾病共病流行病学的详细概述，包括患病率和双向风险；可能与MDD和常见物理疾病的发病机制有关的共享生物途径；作为共同风险和保护因素的社会环境因素；以及MDD和身体疾病的管理，包括预防和治疗。我们总结了与MDD和身体疾病共病患者的最佳护理相关的未来方向和新兴研究。

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引用次数: 0

Labour market marginalization in children of persons with major psychiatric disorders: a Swedish national cohort study. 严重精神疾病患者子女劳动力市场边缘化：瑞典国家队列研究。

IF 73.3 1区医学 Q1 Medicine

World Psychiatry

Pub Date : 2023-10-01 DOI: 10.1002/wps.21127

Ashley E Nordsletten, Kayoko Isomura, James J Crowley, Matti Cervin, Henrik Larsson, Paul Lichtenstein, David Mataix-Cols, Anna Sidorchuk

引用次数: 0