World Journal of Psychiatry最新文献

Background: Major depressive disorder (MDD) and obesity (OB) are bidirectionally comorbid conditions with common neurobiological underpinnings. However, the neurocognitive mechanisms of their comorbidity remain poorly understood.

Aim: To examine regional abnormalities in spontaneous brain activity among patients with MDD-OB comorbidity.

Methods: This study adopted a regional homogeneity (ReHo) analysis of resting-state functional magnetic resonance imaging. The study included 149 hospital patients divided into four groups: Patients experiencing their first episode of drug-naive MDD with OB, patients with MDD without OB, and age- and sex-matched healthy individuals with and without OB. Whole-brain ReHo analysis was conducted using SPM12 software and RESTplus toolkits, with group comparisons via ANOVA and post-hoc tests. Correlations between ReHo values and behavioral measures were examined.

Results: ANOVA revealed significant whole-brain ReHo differences among the four groups in four key regions: The left middle temporal gyrus (MTG.L), right cuneus, left precuneus, and left thalamus. Post-hoc analyses confirmed pairwise differences between all groups across these regions (P < 0.05). OB was associated with ReHo alterations in the MTG.L, right cuneus, and left thalamus, whereas abnormalities in the precuneus suggested synergistic pathological mechanisms between MDD and OB. Statistically significant correlations were found between the drive and fun-seeking dimensions of the behavioral activation system, as well as behavioral inhibition and the corresponding ReHo values.

Conclusion: Our findings provide novel evidence for the neuroadaptive mechanisms underlying the MDD-OB comorbidity. Further validation could lead to personalized interventions targeting MTG.L hyperactivity and targeting healthy food cues.

Background: Intimate partner violence (IPV) is a major public health concern linked to psychiatric and physical morbidity. However, evidence from East Asia, particularly from registry-based and sex-inclusive analyses, remains limited. We hypothesized that IPV survivors would have elevated risks of psychiatric disorders and stress-related physical conditions.

Aim: To assess psychiatric and physical health risks following IPV exposure in Taiwan.

Methods: We conducted a nationwide, registry-based case control study using data from Taiwan's Health and Welfare Data Science Center. Adults aged 18-64 years with a first IPV report in 2019 (n = 43393) were matched 1:1 by sex and age to controls. Incident diagnoses within 1 year were identified from claims data. Conditional logistic regression was used to estimate adjusted odds ratios (AORs).

Results: Compared to controls, IPV survivors had higher risks of depressive disorders [AOR = 4.18, 95% confidence interval (CI): 3.78-4.60, P < 0.001], bipolar disorder (AOR = 4.81, 95%CI: 3.83-6.10, P < 0.001), schizophrenia (AOR = 1.75, 95%CI: 1.46-2.10, P < 0.001), and alcohol/substance use disorders (AOR = 5.98, 95%CI: 2.21-8.50, P < 0.001). The risk of asthma was modestly elevated (AOR = 1.31, 95%CI: 1.08-1.60, P = 0.006). No significant association was observed for irritable bowel syndrome (P = 0.94).

Conclusion: IPV survivors in Taiwan face substantially increased psychiatric risk and a modestly elevated risk of asthma, warranting early screening and integrated mental and physical health care.

Clinically differentiating bipolar II disorder (BD-II) from major depressive disorder (MDD) remains a significant challenge in modern psychiatry. These two conditions share substantial clinical symptomatology, making accurate diagnosis difficult in routine clinical practice. Misdiagnosis may lead to inappropriate treatment strategies, increased psychological and physical burdens, reduced quality of life, and impaired social functioning. Genetic overlap may partially explain the clinical similarities between MDD and BD-II, and biomarkers along with neuroimaging techniques are receiving increasing attention as tools to aid in diagnosis. For example, electroencephalography has been shown to effectively distinguish between unipolar depression and bipolar depression; serum levels of glycogen synthase kinase-3 have also been investigated as a potential tool for differentiating between the two disorders. A comprehensive assessment integrating clinical characteristics, genetic basis research, and multimodal evaluations using neuroimaging and biomarkers through a multidisciplinary approach will help enhance clinicians' ability to distinguish between MDD and BD-II. By improving diagnostic accuracy, more personalized and effective treatment strategies can be developed, ultimately improving patients' health outcomes and quality of life.

Background: There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease (CHD).

Aim: To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.

Methods: This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla. Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.

Results: A greater percentage of parents whose child had a heart defect had anxiety symptoms (50.0%) than did those whose child had no heart defect (24.0%), and the difference in proportions was statistically significant (χ ² = 7.250, P = 0.007). A greater percentage of parents whose child had a heart defect had suicidal ideation (28.0%) than did those whose child had no heart defect (8.0%), and the difference in proportions was statistically significant (χ ² = 6.775 P = 0.009). A positive correlation was elicited between anxiety and suicide ideation, and this correlation was statistically significant (r = 0.748, P < 0.001). A positive correlation was elicited between depression and suicidal ideation scores, and this was statistically significant (r = 0.617, P < 0.001).

Conclusion: There is strong interconnectivity between anxiety and depression with suicidal ideation. There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide. In addition, policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.

Stroke is the second leading cause of death worldwide and a major cause of disability among adults. With the advancement of medical technology, the survival period of stroke patients has been significantly prolonged, but the neuropsychiatric sequelae in the chronic stage have become increasingly prominent. Post-stroke depression is one of the very important manifestations. This article conducts a further discussion on this issue.

Background: Post-stroke depression (PSD) is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction and neurotransmitter deficits. Selective serotonin reuptake inhibitors (SSRIs) are commonly used, but their efficacy is limited. This study investigated whether combining SSRIs with traditional Chinese medicine (TCM) Free San could enhance their therapeutic effects.

Aim: To evaluate the clinical efficacy and safety of combining SSRIs with Free San in treating PSD, and to assess its impact on HPA axis function.

Methods: Ninety-two patients with PSD were enrolled and randomly divided into control groups (n = 46) and study groups (n = 46). The control group received the SSRI paroxetine alone, whereas the study group received paroxetine combined with Free San for 4 weeks. Hamilton Depression Scale and TCM syndrome scores were assessed before and after treatment. Serum serotonin, norepinephrine, cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone were measured. The treatment responses and adverse reactions were recorded.

Results: After treatment, the Hamilton Depression Scale and TCM syndrome scores were significantly lower in the study group than in the control group (P < 0.05). Serum serotonin and norepinephrine levels were significantly higher in the study group than in the control group, whereas cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone levels were significantly lower (P < 0.05). The total efficacy rates were 84.78% and 65.22% in the study and control groups, respectively (P < 0.05). No significant differences in adverse reactions were observed between the two groups (P > 0.05).

Conclusion: Combining SSRIs with Free San can enhance therapeutic efficacy, improve depressive symptoms, and regulate HPA axis function in patients with PSD with good safety and clinical application value.

Background: Suicide constitutes the second leading cause of death among adolescents globally and represents a critical public health concern. The neural mechanisms underlying suicidal behavior in adolescents with major depressive disorder (MDD) remain poorly understood. Aberrant resting-state functional connectivity (rsFC) in the amygdala, a key region implicated in emotional regulation and threat detection, is strongly implicated in depression and suicidal behavior.

Aim: To investigate rsFC alterations between amygdala subregions and whole-brain networks in adolescent patients with depression and suicide attempts.

Methods: Resting-state functional magnetic resonance imaging data were acquired from 32 adolescents with MDD and suicide attempts (sMDD) group, 33 adolescents with MDD but without suicide attempts (nsMDD) group, and 34 demographically matched healthy control (HC) group, with the lateral and medial amygdala (MeA) defined as regions of interest. The rsFC patterns of amygdala subregions were compared across the three groups, and associations between aberrant rsFC values and clinical symptom severity scores were examined.

Results: Compared with the nsMDD group, the sMDD group exhibited reduced rsFC between the right lateral amygdala (LA) and the right inferior occipital gyrus as well as the left middle occipital gyrus. Compared with the HC group, the abnormal brain regions of rsFC in the sMDD group and nsMDD group involve the parahippocampal gyrus (PHG) and fusiform gyrus. In the sMDD group, right MeA and right temporal pole: Superior temporal gyrus rsFC value negatively correlated with the Rosenberg Self-Esteem Scale scores (r = -0.409, P = 0.025), while left LA and right PHG rsFC value positively correlated with the Adolescent Self-Rating Life Events Checklist interpersonal relationship scores (r = 0.372, P = 0.043).

Conclusion: Aberrant rsFC changes between amygdala subregions and these brain regions provide novel insights into the underlying neural mechanisms of suicide attempts in adolescents with MDD.

Background: Non-erosive reflux disease (NERD), the main gastroesophageal reflux subtype, features reflux symptoms without mucosal damage. Anxiety links to visceral hypersensitivity in NERD, yet mechanisms and animal models are unclear.

Aim: To establish a translational NERD rat model with anxiety comorbidity via tail clamping and study corticotropin-releasing hormone (CRH)-mediated neuroimmune pathways in visceral hypersensitivity and esophageal injury.

Methods: Sprague-Dawley (SD) and Wistar rats were grouped into sham, model, and modified groups (n = 10 each). The treatments for the modified groups were as follows: SD rats received ovalbumin/aluminum hydroxide suspension + acid perfusion ± tail clamping (40 minutes/day for 7 days), while Wistar rats received fructose water + tail clamping. Esophageal pathology, visceral sensitivity, and behavior were assessed. Serum CRH, calcitonin gene-related peptide (CGRP), 5-hydroxytryptamine (5-HT), and mast cell tryptase (MCT) and central amygdala (CeA) CRH mRNA were measured via ELISA and qRT-PCR.

Results: Tail clamping induced anxiety, worsening visceral hypersensitivity (lower abdominal withdrawal reflex thresholds, P < 0.05) and esophageal injury (dilated intercellular spaces and mitochondrial edema). Both models showed raised serum CRH, CGRP, 5-HT, and MCT (P < 0.01) and CeA CRH mRNA expression (P < 0.01). Behavioral tests confirmed anxiety-like phenotypes. NERD-anxiety rats showed clinical-like symptom severity without erosion.

Conclusion: Tail clamping induces anxiety in NERD models, worsening visceral hypersensitivity via CRH neuroimmune dysregulation, offering a translational model and highlighting CRH as a treatment target.

Background: The previous studies have primarily focused on the influence of botulinum toxin A (BoNT-A) injection on emotions during the period of peak motor symptom improvement in blepharospasm patients, based on facial feedback hypothesis.

Aim: To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.

Methods: We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale, Blepharospasm Disability Index, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Hamilton Anxiety Scale and Hamilton Depression Scale between pre-treatment (baseline) and pre-reinjection (treatment), to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.

Results: A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6. Significantly decreases in the subscale scores of SDS and SAS, including SDS well-being index, decreased capacity and hard to decide, SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and post-treatment. With each additional BoNT-A injection, the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%. Moreover, BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.

Conclusion: This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.

Background: Approximately 30% of patients with head and neck cancer experience adverse effects caused by anxiety and depression. Considering the high prevalence, implementing customized interventions to ease adverse emotional states is imperative.

Aim: To evaluate the efficacy of cognitive behavioral therapy (CBT)-based psychological interventions in improving the psychological well-being and quality of life (QoL) of patients with laryngeal carcinoma.

Methods: This study enrolled 120 patients admitted from February 2022 to February 2024. The control group, comprising 50 participants, received standard supportive psychological care, while the research group, consisting 70 participants, underwent CBT-based interventions. Several clinical outcomes were systematically assessed that included postoperative recovery metrics (duration of tracheostomy and nasogastric tube dependence and length of hospitalization), psychological status (Self-Rating Anxiety Scale and Self-Rating Depression Scale), nutritional markers (serum albumin and hemoglobin levels), sleep quality (Self-Rating Scale of Sleep and Athens Insomnia Scale), and QoL (Functional Assessment of Cancer Therapy-Head and Neck).

Results: The results demonstrated that the research group experienced superior outcomes, with significantly reduced durations of tracheostomy and nasogastric tube dependence, as well as shorter hospital stays, compared with the control group. Additionally, the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale, Self-Rating Depression Scale, Self-Rating Scale of Sleep, and Athens Insomnia Scale scores, along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group. All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group, exceeding those observed in the control group.

Conclusion: CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma, highlighting its potential for broader clinical application.