World Journal of Psychiatry最新文献

The increasing global prevalence of mild cognitive impairment (MCI) necessitates a paradigm shift in early detection strategies. Conventional neuropsychological assessment methods, predominantly paper-and-pencil tests such as the Mini-Mental State Examination and the Montreal Cognitive Assessment, exhibit inherent limitations with respect to accessibility, administration burden, and sensitivity to subtle cognitive decline, particularly among diverse populations. This commentary critically examines a recent study that champions a novel approach: The integration of gait and handwriting kinematic parameters analyzed via machine learning for MCI screening. The present study positions itself within the broader landscape of MCI detection, with a view to comparing its advantages against established neuropsychological batteries, advanced neuroimaging (e.g., positron emission tomography, magnetic resonance imaging), and emerging fluid biomarkers (e.g., cerebrospinal fluid, blood-based assays). While the study demonstrates promising accuracy (74.44% area under the curve 0.74 with gait and graphic handwriting) and addresses key unmet needs in accessibility and objectivity, we highlight its cross-sectional nature, limited sample diversity, and lack of dual-task assessment as areas for future refinement. This commentary posits that kinematic biomarkers offer a distinctive, scalable, and ecologically valid approach to widespread MCI screening, thereby complementing existing methods by providing real-world functional insights. Future research should prioritize longitudinal validation, expansion to diverse cohorts, integration with multimodal data including dual-tasking, and the development of highly portable, artificial intelligence-driven solutions to achieve the democratization of early MCI detection and enable timely interventions.

Selecting the initial antipsychotic dose is a high-impact decision in acute schizophrenia. A randomized study found that starting lurasidone at 80 mg/day for 1 week (then flexible titration) produced earlier reductions in Positive and Negative Syndrome Scale positive symptoms than 40 mg/day, without higher discontinuations for adverse events or a metabolic penalty over 6 weeks. These data support an individualized approach: Start at 80 mg/day when rapid control of positive symptoms or agitation is needed and tolerance permits; start at 40 mg/day when akathisia risk or patient preference argues for caution, with a planned day-7 review for up-titration. The open-label design, dose convergence after week 1, and the lack of stratified randomization limit attribution of longer-term advantages to starting dose. Even so, the trial reframes initial dose as a modifiable lever for the early course rather than a one-size-fits-all rule and warrants confirmation in larger, double-blind randomized trials.

Recently, inflammatory cytokine profiles have been linked to suicide risk in adolescents with non-suicidal self-injury, highlighting a promising biological dimension of suicide risk assessment. Clinical translation of the cytokine profiles into practice will require frontline engagement of the workforce. Mental health nurses are frequently the most accessible professionals in schools, communities, and low-resource settings and are prime candidates to bridge this gap. By integrating psychosocial evaluation with emerging biomarker data, they can deliver systematic risk assessment, continuous monitoring, and timely intervention. This role would not replace psychiatric expertise; it would extend the reach of psychiatric services, embedding suicide prevention across the continuum of care. For health systems, nurse-led integration may enhance capacity, equity, and resilience in responding to adolescent suicide risk. This editorial demonstrates that empowering nurses to operationalize biomarker-informed strategies is needed for advancing effective and sustainable suicide prevention in this vulnerable population.

Background: Parkinson's disease (PD) is a common neurodegenerative disorder in the elderly population. Non-motor symptoms such as anxiety and depression are often subtle, hindering early detection and intervention, yet they markedly affect quality of life and clinical outcomes.

Aim: To investigate the prevalence of anxiety and depression in elderly PD patients, identify associated risk factors, and assess their relationship with fatigue severity.

Methods: A cross-sectional analysis was conducted in 123 elderly PD patients treated at The Second Rehabilitation Hospital of Shanghai between January 2023 and December 2024. Demographic and clinical data were obtained using standardized questionnaires. Anxiety, depression, and fatigue were assessed using the Beck Anxiety Inventory (BAI), Geriatric Depression Scale (GDS), and Fatigue Scale-14 (FS-14), respectively. Binary logistic regression identified risk factors for anxiety and depression, whereas Spearman's correlation assessed associations with fatigue.

Results: Anxiety and depression prevalence rates were 64.2% (mean BAI score: 19.59 ± 10.92) and 56.1% (mean GDS score: 12.82 ± 6.37), respectively. The mean FS-14 total score was 9.46 ± 1.89, comprising physical (5.77 ± 1.51) and mental (3.69 ± 1.20) fatigue components. Significant positive correlations were observed between fatigue scores (total, physical, and mental) and both anxiety and depression (all P < 0.05). Univariate analysis revealed statistically significant associations between anxiety/depression and monthly income, disease duration, and disease severity (all P < 0.05). Multivariate logistic regression indicated higher anxiety risk in patients with lower monthly income, prolonged disease duration, advanced disease severity, or multimorbidity. Depression risk was elevated in patients with lower monthly income and severe disease, whereas longer disease duration unexpectedly served as a protective factor.

Conclusion: Elderly PD patients show high rates of anxiety and depression, both of which are significantly correlated with fatigue severity. These findings highlight the importance of psychological monitoring and targeted mental health interventions in PD management among the elderly.

Background: Timely and accurate evaluation of mental disorders in adolescents using appropriate mental health literacy assessment tools is essential for improving their mental health literacy levels.

Aim: To develop an evaluation index system for the mental health literacy of adolescent patients with mental disorders, providing a scientific, comprehensive, and reliable tool for the monitoring and intervention of mental health literacy of such patients.

Methods: From December 2022 to June 2023, the evaluation index system for mental health literacy of adolescents with mental disorders was developed through literature reviews, semi-structured interviews, expert letter consultations, and the analytic hierarchy process. Based on this index system, a self-assessment questionnaire was compiled and administered to 305 adolescents with mental disorders to test the reliability and validity of the index system.

Results: The final evaluation index system for mental health literacy of adolescents with mental disorders included 4 first-level indicators, 10 second-level indicators, and 52 third-level indicators. The overall Cronbach's α coefficient of the index system was 0.957, with a partial reliability of 0.826 and a content validity index of 0.975. The cumulative variance contribution rate of 10 common factors was 66.491%. The correlation coefficients between each dimension and the total questionnaire ranged from 0.672 to 0.724, while the correlation coefficients in each dimension ranged from 0.389 to 0.705.

Conclusion: The evaluation index system for mental health literacy of adolescents with mental disorders, developed in this study, demonstrated notable reliability and validity, making it a valuable tool for evaluating mental health literacy in this population.

Background: Ischemic stroke is one of the leading global causes of disability and death. Despite advances in modern medical technology that improve acute treatment and rehabilitation measures, post-stroke anxiety and depression (PSD) do not receive sufficient attention.

Aim: To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.

Methods: This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024. Based on assessments using the Hamilton Rating Scale for Anxiety (HAMA) and Hamilton Rating Scale for Depression (HAMD) at 2 weeks (± 3 days) post-stroke, patients were classified into the PSD group (HAMA ≥ 7 and/or HAMD ≥ 7) and the non-PSD group (HAMA < 7 and HAMD < 7). Observation indicators included psychological assessment, demographic and clinical characteristics, stroke-related clinical indicators, neuroimaging assessments, and laboratory biomarkers. Multivariate logistic regression analysis was used to identify independent risk factors for PSD, and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.

Results: Of the 112 patients, 46 (41.1%) were diagnosed with PSD. Multivariate analysis identified five independent risk factors: Female gender [Odds ratio (OR) = 2.32, 95% confidence interval (CI): 1.56-3.45], history of mental disorders prior to stroke (OR = 3.17, 95%CI: 1.89-5.32), infarct location in the frontal lobe or limbic system (OR = 2.86, 95%CI: 1.73-4.71), stroke severity with National Institutes of Health Stroke Scale ≥ 8 at admission (OR = 2.54, 95%CI: 1.62-3.99), and low social support (Social Support Rating Scale < 35, OR = 2.18, 95%CI: 1.42-3.36). Subgroup analysis showed that depression patients more commonly had left hemisphere lesions (68.4% vs 45.2%), while anxiety patients more frequently presented with right hemisphere lesions (59.5% vs 39.5%). The PSD group exhibited larger infarct volumes (8.7 cm³ vs 5.3 cm³), more severe white matter hyperintensities, and more pronounced frontal lobe atrophy. Analysis of inflammatory markers showed significantly elevated levels of interleukin-6 (7.8 pg/mL vs 4.5 pg/mL) and tumor necrosis factor-alpha (15.6 pg/mL vs 9.8 pg/mL) in the PSD group, while hypothalamic-pituitary-adrenal axis function assessment revealed higher cortisol levels (386.5 ± 92.3 nmol/L vs 328.7 ± 75.6 nmol/L) and flattened diurnal rhythm in the PSD group.

Conclusion: PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry, neuroinflammatory responses, and dysfunction of the hypothalamic-pituitary-adrenal axis.

Background: Appropriate care for individuals who attempt suicide and are admitted to the emergency department (ED) can prevent future suicidal behavior. It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.

Aim: To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.

Methods: Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture (Hubei Province, China) between January 2021 and February 2025 were divided into 2: Control (n = 108) and psychological care (n = 131). The demographic characteristics and effects of the psychological care were analyzed.

Results: The mean (± SD) age of the 239 patients [114 male (47.7%), 125 female (52.3%)] was 26.25 ± 9.3 years, of whom 122 (45.2%) were single, 117 (48.9%) were married, and 106 (44.4%) had secondary education. Thirty-eight (15.9%) patients had suicidal intent, with a mean of 1.26 ± 0.59 suicide attempts each. Twenty-two (9.21%) patients had a family history of suicide, while 8 (3.34%) had a family history of suicide attempt(s). Before intervention, mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57 ± 5.28 and 19.86 ± 5.92, respectively (P > 0.05). After 1 month of nursing intervention, the respective scores were 10.09 ± 1.11 and 16.48 ± 0.87 (P < 0.001); and the re-suicide rates were 11.45% (15/131) and 24.07% (26/108) (P < 0.001).

Conclusion: Psychological care significantly reduces suicide risk; EDs should provide comprehensive mental health care.

Background: Anxiety, depression, and other negative emotions are common among patients with chronic renal failure (CRF). Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.

Aim: To explore the correlations among life satisfaction, pleasure levels, and negative emotions in patients with CRF.

Methods: One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included. The Depression, Anxiety, and Stress Scale (DASS-21), Satisfaction with Life Scale (SWLS), and Temporal Experience of Pleasure Scale (TEPS) were used to evaluate negative emotions, life satisfaction, and pleasure level, respectively. Pearson's correlation coefficient analyzed the correlation between life satisfaction, pleasure level, and negative emotions. Linear regression analysis identified the factors affecting negative emotions.

Results: The average DASS-21 score among patients with CRF was 51.90 ± 2.30, with subscale scores of 17.90 ± 1.50 for depression, 18.53 ± 1.18 for anxiety, and 15.47 ± 2.36 for stress, all significantly higher than the domestic norm (P < 0.05). The average SWLS score was 22.17 ± 4.90. Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores (P < 0.05), but not with the individual depression, anxiety, or stress dimensions. The average TEPS score was 67.80 ± 8.34. TEPS scores were negatively correlated with the DASS-21 score and the stress dimension (P < 0.05), but not with depression or anxiety. Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores (P < 0.05).

Conclusion: Patients with CRF experience high levels of negative emotions, which are negatively correlated with life satisfaction and pleasure. Furthermore, pleasure level had an impact on negative emotions.

Background: Perimenopausal women are prone to anxiety and depression due to fluctuating hormone levels, which significantly impair their quality of life. The current treatments have certain limitations. In traditional Chinese medicine, liver-soothing formulas are commonly prescribed for mood-related disorders, but their overall efficacy in perimenopausal anxiety and depression remains uncertain and requires verification through meta-analysis.

Aim: To provide evidence-based support for clinical decision-making and research, a meta-analysis was conducted to evaluate the effectiveness of liver-soothing formulas in treating perimenopausal anxiety and depression.

Methods: Relevant studies published up to April 2025 were retrieved from ClinicalTrials.gov, PubMed, Web of Science, EMBASE, and the Cochrane Library. Eligible studies were screened according to predefined inclusion and exclusion criteria. Data were extracted and analyzed using the Stata 12.0 software.

Results: After searching and screening, 12 articles involving 1798 patients (922 in the treatment group and 876 in the control group) were included in the analysis. Meta-analysis showed that the standardized scores for anxiety [standardized mean difference (SMD) = -0.71, 95% confidence interval (95%CI): -1.06 to -0.36] and depression (SMD = -0.67, 95%CI: -1.06 to -0.27) of the treatment group were lower than those of the control group. Subgroup analysis results revealed that for anxiety, liver-soothing formulas used alone (SMD = -0.34, 95%CI: -0.50 to -0.18) or in combination (SMD = -0.88, 95%CI: -1.43 to -0.34) both significantly reduced scores compared with the control group. For depression, monotherapy of liver-soothing formulas showed no significant statistical difference between the treatment and control groups (SMD = -0.47, 95%CI: -1.11 to 0.17), whereas combination therapy produced significantly lower standardized scale scores in the treatment group than in the control group, with a statistically significant difference (SMD = -0.83, 95%CI: -1.39 to -0.28). Regarding Greene scores, no statistically significant difference was observed with monotherapy (SMD = 0.87, 95%CI: -0.32 to 2.06), whereas combination therapy had significantly lower Greene scores (SMD = -0.24, 95%CI: -0.44 to -0.04). No statistically significant difference was found between the groups in the occurrence of adverse reactions (odds ratio = 0.90, 95%CI: 0.57-1.43). However, liver-soothing formulas did not affect estrogen levels in perimenopausal women.

Conclusion: Compared with placebo, conventional Western medicine, or other interventions, the monotherapy of liver-soothing formulas demonstrates superior efficacy in treating perimenopausal anxiety. When used as an adjuvant, they exert a synergistic effect in alleviating negative emotions and improving overall perimenopausal symptoms.

Rheumatoid arthritis (RA) patients face significant psychological challenges alongside physical symptoms, necessitating a comprehensive understanding of how psychological vulnerability and adaptation patterns evolve throughout the disease course. This review examined 95 studies (2000-2025) from PubMed, Web of Science, and CNKI databases including longitudinal cohorts, randomized controlled trials, and mixed-methods research, to characterize the complex interplay between biological, psychological, and social factors affecting RA patients' mental health. Findings revealed three distinct vulnerability trajectories (45% persistently low, 30% fluctuating improvement, 25% persistently high) and four adaptation stages, with critical intervention periods occurring 3-6 months post-diagnosis and during disease flares. Multiple factors significantly influence psychological outcomes, including gender (females showing 1.8-fold increased risk), age (younger patients experiencing 42% higher vulnerability), pain intensity, inflammatory markers, and neuroendocrine dysregulation (48% showing cortisol rhythm disruption). Early psychological intervention (within 3 months of diagnosis) demonstrated robust benefits, reducing depression incidence by 42% with effects persisting 24-36 months, while different modalities showed complementary advantages: Cognitive behavioral therapy for depression (Cohen's d = 0.68), mindfulness for pain acceptance (38% improvement), and peer support for meaning reconstruction (25.6% increase). These findings underscore the importance of integrating routine psychological assessment into standard RA care, developing stage-appropriate interventions, and advancing research toward personalized biopsychosocial approaches that address the dynamic psychological dimensions of the disease.