World Journal of Psychiatry最新文献

Despite the well-established functions of neurotransmitters and their receptors in depression studies, the aetiology of depression remains unknown. Further research into the field of animal studies is required in order to facilitate a more comprehensive understanding of the underlying mechanisms that contribute to the development of depression. While the potential of animal behaviour to elucidate the molecular underpinnings of depression remains to be elucidated, the establishment of animal models can facilitate the identification of analogous pathogenic pathways through the application of rigorous methodologies. Animal models that are suitable for simulating the illness state of human depression can be utilised to investigate the pathophysiology of depression and the development of novel antidepressant medications. Currently, there is an absence of an optimal animal model that can fully replicate the pathogenic pathways of human depression, which limits future research in this field. It is evident that stress constitutes the primary catalyst for the onset of depressive states, a phenomenon that has been observed in both human and animal subjects. From this standpoint, animal models of stress-induced depression should be better equipped to simulate the onset process of human depression. This study offers a comprehensive summary and analysis of the most frequently employed rodent models of depression, with a view to providing a more diverse range of models and resources for animal studies in the field of depression research.

Background: Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders, even during remission. Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery. By comparing remitted bipolar disorder (BD) and major depressive disorder (MDD) patients with healthy controls, the present study sought to clarify the extent of these disturbances and their correlates.

Aim: To evaluate differences in sleep quality, psychosocial functioning, and insomnia severity among remitted patients with BD and MDD, in comparison with healthy controls. A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.

Methods: The study included 135 participants: 45 remitted BD patients, 45 remitted MDD patients, and 45 healthy controls. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, psychosocial functioning with the global assessment of functioning, and insomnia severity with the Insomnia Severity Index. Sociodemographic and clinical characteristics were also recorded. Comparative analyses were conducted to evaluate differences between groups, and regression models were used to identify predictors of sleep quality.

Results: Both BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls. Poor sleep quality was observed in 75.6% of BD patients and 57.8% of MDD patients. Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency, sleep duration, and habitual sleep efficiency. Regression analysis identified insomnia severity (β = 0.510) and functional capacity (β = -0.043) as significant correlates of sleep quality, indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.

Conclusion: The findings underscore that even during remission, BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning. These results highlight the importance of addressing residual symptoms, particularly insomnia and functional difficulties, in long-term management strategies. Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.

In this article, we comment on the recent network analysis by Li et al, which explores depression, anxiety, and their associated factors in individuals with noncommunicable chronic diseases (NCDs). We highlight three often-overlooked domains in this population: Mental vulnerability (depression, anxiety, fatigue, nervousness), dysfunction in family functioning (family health, intimate partner violence), and digital exposure (media exposure, problematic internet use), and examine their dynamic interrelations within a psychosocial network framework. The findings reveal a complex system in which emotional dysregulation, family relational adversity, and digital behaviors mutually reinforce one another to heighten psychiatric risk. Notably, traditional demographic factors such as gender, ethnicity, and residence had minimal impact on overall network strength. We argue that these interconnected domains represent modifiable yet underrecognized targets for mental health intervention among medically vulnerable populations. Strategies that promote emotional resilience, strengthen family systems, and enhance digital literacy may play a pivotal role in disrupting maladaptive network pathways and improving quality of life for individuals with NCDs. Future research should prioritize longitudinal and multimodal designs to clarify causal mechanisms and support tailored, systems-level psychosocial interventions.

The high comorbidity rates of depression and chronic obstructive pulmonary disease (COPD) have garnered widespread attention. As a refractory disease, its long-term stress effects exacerbate the coexistence of depression. Depression is linked to a decline in lung function in patients with COPD through reduced heart rate variability, increased inflammatory cytokines, dysregulation of the hypothalamic-pituitary-adrenal axis, and the interplay of various biological and psychological factors. Sole reliance on biomedical treatment cannot fully counteract these negative effects, which are detrimental to improving patients' quality of life and long-term prognosis. Antidepressant medications and traditional Chinese medicine combined with conventional COPD therapy, psychotherapy (e.g., cognitive behavioral therapy, mindfulness training), and lifestyle adjustments (e.g., yoga, qigong, or walking) can not only alleviate depression and compensate for the limitations of biomedical approaches but also help improve heart rate variability and lung function. In this editorial, we suggest that clinicians, when prescribing antidepressants, must carefully weigh the benefit-risk ratio based on the patient's specific physical condition to ensure precise medication use.

Background: Adolescent depression manifests through diverse, interconnected symptoms, yet the clinical profile in patients treated with repetitive transcranial magnetic stimulation (rTMS) remains inadequately characterized. While rTMS shows therapeutic potential, its efficacy may be overestimated due to limited research and symptom heterogeneity. Identifying key symptom clusters and evaluating their predictive value for treatment response is crucial for optimizing rTMS outcomes in this population.

Aim: To identify adolescent depression symptom clusters and assess their differential responses to rTMS treatment.

Methods: One hundred adolescent patients with first-episode major depressive disorder were randomized into control and study groups. Both groups received sertraline treatment, while the study group additionally underwent 10 sessions of adjunctive rTMS. Depressive symptoms were evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17) at baseline, week 2, and week 4.

Results: Hierarchical clustering revealed four distinct symptom clusters: Subjective mood, impaired activity, somatic concerns, and anxiety/insomnia. The main effect of treatment visit showed significant decreases in symptom severity across all clusters. In the study group, the effect size between baseline and week 4 was largest for the subjective mood cluster (Cohen's d = 2.41) and smallest for somatic concerns (Cohen's d = 0.59). In the control group, the largest effect size was observed in the anxiety/insomnia cluster (Cohen's d = 1.20), with the smallest effect in impaired activity (Cohen's d = 0.47).

Conclusion: This study identified four distinct symptom clusters with differential responses to rTMS treatment. The findings demonstrate that rTMS shows greatest efficacy for improving subjective mood symptoms, guiding targeted therapeutic approaches.

Medication adherence in patients with schizophrenia is essential for managing symptoms, improving prognosis, and enhancing the quality of life. Despite the importance of adherence, it remains a global challenge. It is influenced by various factors, including symptom severity (e.g., excitement and impulse control disorders), attitudes towards medication (e.g., pharmacophobia), lack of social support, and the communication efficacy of healthcare teams. Regarding assessment tools, self-report questionnaires, such as the Morisky Scale, are common but subject to recall bias. Electronic monitoring devices (e.g., Medication Event Monitoring System) and pharmacy refill data offer more objective measures of adherence, whereas biomarkers, such as blood drug concentration monitoring, show promise under specific conditions but require further validation. Long-acting injectable antipsychotic medications have shown greater adherence benefits than oral medications. Psychological interventions such as motivational interviewing and mindfulness training, along with multidisciplinary team efforts, including psychiatrists, pharmacists, and psychotherapists, can significantly improve patient outcomes. Future research should integrate innovative drug formulations (e.g., long-acting, low-side-effect medications), digital health technologies (e.g., medication reminder apps and wearable devices), and supportive policies (e.g., community-based free medication services) as well as patient education to enhance disease awareness. However, the ethical and legal dilemmas (e.g., balancing patient autonomy with involuntary medication) and privacy concerns in technological applications require further exploration. In conclusion, enhancing medication adherence in patients with schizophrenia requires a personalized, multifaceted approach, and collaborative efforts across various sectors to achieve optimal clinical results and social functioning.

Background: Excessive video game use, recognized as internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and Gaming Disorder in International Classification of Diseases, 11^th Revision, has raised concerns regarding its effects on individuals' social well-being.

Aim: To analyze the association between internet gaming disorder and social interaction across Western and Asian populations.

Methods: The review examined 14 observational studies published between 2000 and 2025. It assessed the frequency and quality of face-to-face interactions, the shift towards online socialization, and the methodological quality of the included studies.

Results: The findings generally indicate that gaming addiction is associated with a decrease in the frequency of offline social interaction. Addicted gamers reported spending less time with family and friends and experiencing increased isolation. Furthermore, the quality of social relationships appeared poorer, with addicted gamers reporting higher levels of loneliness, lower social support, and decreased relationship satisfaction. While online social interactions increased, they did not fully compensate for the loss of real-world connections.

Conclusion: This review highlights the potential of gaming addiction to negatively impact overall social lives, emphasizing the necessity for interventions focused on promoting real-world social engagement.

Background: Hepatocellular carcinoma (HCC) is a common and frequently encountered malignancy in clinical practice. Patients who lack understanding of the disease and surgical treatment are prone to fear, depression, and other negative emotions, which further aggravate psychological stress. As such, less stimulating and minimally invasive surgical modalities, such as ultrasound-guided interventions, should be adopted to alleviate or eliminate negative perioperative psychological states, which can be evaluated using validated tools such as the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D).

Aim: To investigate the impact of ultrasound-guided surgery on stress, complications, and recovery in patients with HCC and comorbid anxiety/depression.

Methods: Ninety patients with primary small HCC and comorbid anxiety/depression were randomly divided into 2 groups according to treatment (n = 45 each): Experimental (ultrasound-guided intervention); and control (conventional laparoscopic hepatectomy). The HAM-A and HAM-D were used to assess psychological states before and 1 week after surgery. C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and superoxide dismutase (SOD) levels, in addition to specific liver-function indicators, complication rates, and postoperative metrics were measured. Recurrence rates were monitored for 6 months.

Results: There were no significant differences in preoperative HAM-A and HAM-D scores between the 2 groups (P > 0.05); however, scores in the study group were significantly lower postoperatively (P < 0.05). On postoperative day 1, there were no significant differences in serum levels of CRP, VEGF, or SOD between the groups (P > 0.05), whereas the levels in the intervention group were significantly lower than those in the control group on days 3 and 7 (P < 0.05). The incidence of postoperative complications in the study group (6.66%) was significantly lower than that in the control group [17.78% (P < 0.05)]. The study group also had a significantly shorter time to first flatus, oral intake, and postoperative hospital stay (P < 0.05). Postoperative serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels decreased in both groups compared with preoperative levels, although with significantly lower values in the study group (P < 0.05) but no differences preoperatively (P > 0.05). There was no statistical difference in tumor recurrence rates between the 2 groups during the six-month follow-up (P > 0.05).

Conclusion: Ultrasound-guided intervention for patients with primary small HCC and anxiety/depression effectively improves negative emotional states, reduce stress responses, decreases postoperative complications, promotes recovery, and enhances quality of life.

Background: Chronic heart failure (CHF) has a prolonged clinical course, and patients commonly experience fatigue. It remains unclear whether anxiety and depression exacerbate fatigue in patients with CHF.

Aim: To examine the correlation of fatigue status with anxiety and depression in patients with CHF and identify factors influencing fatigue.

Methods: This observational study included 162 patients with CHF who visited the Department of Cardiology, Suzhou Ninth Hospital Affiliated to Soochow University, between May 2023 and May 2025. Fatigue was assessed using the Chinese version of the Multidimensional Fatigue Scale (MFI-20). Anxiety and depression were evaluated with the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Patient demographic and clinical data were collected using a general information questionnaire. Pearson correlation analysis was used to assess the relationship between fatigue, anxiety, and depression, while multiple linear regression analysis was conducted to identify factors influencing fatigue levels.

Results: The mean MFI-20 fatigue score among the 162 patients with CHF was 70.76 ± 8.42. The mean SAS score was 58.87 ± 9.92, and the mean SDS score was 54.76 ± 7.91. Both SAS and SDS scores were positively correlated with MFI-20 scores (r = 0.479, r = 0.468; both P < 0.001). Multivariate regression analysis identified comorbidities [β = 0.903, 95% confidence interval (CI): 0.258-1.695], New York Heart Association functional class (III-IV) (β = 0.319, 95%CI: 0.269-0.743), poor sleep quality (β = 0.465, 95%CI: 0.294-0.948), anxiety (β = 1.728, 95%CI: 0.693-3.642), and depression (β = 1.649, 95%CI: 0.712-3.517) as significant factors influencing fatigue (P < 0.05).

Conclusion: Fatigue levels in patients with CHF were high and significantly influenced by comorbidities, advanced New York Heart Association functional class (III-IV), poor sleep quality, anxiety, and depression. Clinical interventions that address comorbid conditions, improve cardiac function, and provide sleep and psychological support may help alleviate fatigue in this population.