NEUROPSYCHIATRIE最新文献

Urbanization and digitalization are reshaping the landscape of mental health, contributing to increased social isolation, stress, and the emergence of novel psychopathologies. This paper explores the impact of urbanization on mental health, with a particular focus on two contemporary phenomena: "Hikikomori" (severe social withdrawal) and "Modern-Type Depression (MTD)." These conditions highlight the need for psychiatrists to adopt innovative, interdisciplinary approaches that integrate sociocultural understanding and technological advancements. By utilizing digital tools such as metaverse and communication robots, mental healthcare can evolve to effectively address these emerging challenges. Moreover, following the COVID-19 pandemic, hikikomori may hold the potential to evolve from a pathological condition into a new lifestyle for human beings.

Purpose and research question of the review: Despite its substantial therapeutic efficacy-particularly in the acute treatment and relapse prevention of bipolar affective disorders-lithium is associated with a broad spectrum of side effects, among which potential nephrotoxicity represents one of the most significant long-term risks. In clinical practice, particularly in the treatment of older adults, physicians are often faced with the question of whether lithium therapy can or should be continued, or whether initiation is feasible, given comorbid somatic illnesses, polypharmacy, or reduced glomerular filtration rate (GFR). The aim of this review is to provide practical, evidence-based recommendations for clinical decision-making.

Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar, focusing on the treatment of patients with bipolar and unipolar affective disorders with lithium and its potential effects on renal function, particularly in the context of long-term therapy and aging. A case report is included to illustrate clinical application.

Results and conclusions: Lithium remains a cornerstone in the pharmacological treatment of bipolar and unipolar affective disorders, despite its known nephrotoxic potential. Optimizing the balance between therapeutic benefit and potential renal risks necessitates close monitoring and individualized treatment adjustments. The risk of lithium-induced nephropathy increases with the duration of therapy, patient age, and the frequency of episodes of lithium toxicity or overdose. Current guidelines recommend maintaining serum lithium levels within a range of 0,6-0,8 mmol/L. In older patients with good treatment response, target levels at the lower end of the therapeutic window (0,4-0,6 mmol/L) are advised. Lithium therapy should be monitored at regular intervals, including laboratory testing and 12-hour serum level checks every three months, or every 8-10 weeks in elderly patients. If GFR falls below 30 ml/min/1,73 m², nephrology consultation is warranted, and the continuation of lithium treatment should be critically re-evaluated. In patients with a GFR below 45 ml/min/1,73 m², initiation of lithium therapy in old age is not recommended. Decisions regarding the discontinuation or initiation of lithium therapy should always be made on an individual and interdisciplinary basis, carefully weighing the therapeutic benefit against the risk of affective relapse and the potential for progressive renal impairment.

Background: Vocalizations in dementia patients are repetitive verbal expressions that, due to their volume, frequency, and/or social inappropriateness, cause negative effects on patients and other individuals present. The prevalence ranges up to 30%. Given the increasing global incidence of dementia and the limited number of randomized controlled trials about treating repetitive vocalizations, this systematic review provides a summary of existing works on the effectiveness of potential pharmacotherapeutic and nonpharmacological therapies.

Methods: The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration page (registration number: CRD42023486344). Literature search was conducted in PubMed and Embase databases. Due to insufficient data, case reports were also included.

Results: Of 2635 articles, 25 studies were included in the review. Efficacy was demonstrated for selective serotonin reuptake inhibitors (SSRIs), pregabalin, gabapentin, and the antipsychotics haloperidol and risperidone based on a few case reports, albeit with associated side effects. Nonpharmacological interventions also showed efficacy.

Conclusion: Both pharmacological and nonpharmacological interventions are effective treatment approaches for repetitive vocalizations in dementia patients. Due to the fact that there are hardly any randomized controlled studies available, the results of this systematic review must be interpreted with caution. The results of this review show that randomized controlled trials are required for many interventions.

Background: Psychological constructs of individual autonomy (IA) and emotional connectedness (EC) differ between patients with anorexia nervosa (AN) and bulimia nervosa (BN); however, it is unclear whether objective family factors modulate these associations.

Methods: In a cohort of 445 participants from the FamFINED study (FAMily Factors INvolved in Eating Disorders) with eating disorders (EDs) diagnosed as AN (n = 232) or BN (n = 213), we assessed objective psychosocial family factors as well as the IA and EC constructs using the self-rated Subjective Family Image Test (SFIT) questionnaire.

Results: While the two ED entities did not differ with respect to IA in univariate analysis (p = 0.355), patients diagnosed with AN had higher perceived EC than participants with BN, as assessed by a lower score for the difference between the actual and desired family image (16.0 ± 15.8 vs. 21.6 ± 17.6, p < 0.001). In a regression model adjusted for age, body-mass index, living in parental home, and parental separation, we found that the EC score used as the dependent variable differed significantly between the two ED entities (expβ = 4.8, 95% confidence interval = 0.54-9.11, p = 0.028). In contrast, no association was observed between IA and ED diagnoses using the same set of confounders (p = 0.717).

Conclusion: The higher perceived EC in AN patients compared to those diagnosed with BN indicates more intense feelings of family solidarity, regardless of objective family factors.

The World Psychiatric Association (WPA) advocates for a practical approach to implementing alternatives to coercion in mental health care. It adopted a Position Statement and Call to Action in 2020 that give special attention to provisions of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The WPA aims to continue promoting rights-based policies and practices through mutual support across its member societies in more than 120 countries. Collaborating with people with lived experience of mental health conditions and their families, and other government, research, and civil society groups is a prerequisite for this process. The call to action is relevant for people at all life stages and in all countries irrespective of resources available. The work aims to demonstrate how shared experiences and outcomes assessments can promote the spread of good practices and improved quality of mental health care. Culturally sensitive changes to treatment and care including priority for early intervention and personalised care are needed in most places. Changes are needed to policy, laws, attitudes, human and financial resources, training and research, open access to data about coercive practices, and above all readiness and capacity to work with people with lived experience and their families.

The occurrence and experience of psychotic disorders are shaped by contextual factors. Designing effective and appropriate interventions for affected persons should therefore take cognizance of the settings where such individuals live. Sub-Saharan Africa (SSA) is characterised by scarce mental health resources and paucity of research data. Even though earlier clinical studies on the continent have broadly replicated findings in other settings, the scope of such research is still very limited, with major gaps remaining in our understanding of the extent and profile of the condition in the community. The continent is undergoing profound social changes which, along with the rampant economic challenges, may offer unique opportunities to explore new insight into the disorder. Such insights may include new understanding of the factors determining the onset and course of psychosis as well as innovative ways to deliver affordable and culturally appropriate evidence-based care for persons experiencing the condition.

Background: Jonathan Swift (1667-1745) had long been interested in mental disease, which he also (ab)used for satirical purposes. He characterized various forms of madness in 1704, was elected governor of Bedlam in 1714, and in 1731 decided to dedicate his fortune to the founding of a first lunatic asylum in Ireland.

Objective: To identify and consider the nature of neuropsychiatric features described in Gulliver's Travels.

Material & methods: Literary works by and biographies of Jonathan Swift were examined together with the pertinent medical and historical specialist literature.

Results: Gulliver's Travels, primarily a political satire, was published 300 years ago. The adventures of the restless naval surgeon Lemuel Gulliver on various remote islands can be understood as a journey into psychosis with characteristic motor, sensory and cognitive features. After his return home an autistic Gulliver refuses contact with his own species, the Yahoo-like humans, including his family and prefers the company of horses. Seamen and lunatic inpatients apparently shared a number of environmental risk factors and features of scorbutic nostalgia.

Conclusion: Caution is advised when making a retrospective diagnosis, even with a fictional character like Lemuel Gulliver. If there were no hints at relevant organic causes-primarily hypovitaminoses-, one might suggest that Swift/Gulliver reported a number of characteristic symptoms of schizophrenia long before they were described in the medical literature.

The digitalization of mental health care has ushered in transformative possibilities for enhancing access, diagnosis, and treatment through technologically enabled tools and platforms. However, this evolution presents substantial risks that warrant careful consideration. This paper critically examines the psychological, ethical, cultural, and clinical challenges embedded in digital mental health practices. Key concerns include diminished clinical oversight, compromised patient data security, algorithmic bias in diagnostic and therapeutic algorithms, and the erosion of traditional therapeutic relationships. Cultural disparities in digital literacy and engagement further complicate equitable care delivery. Through a multidisciplinary lens, the paper explores how these risks may impact both care outcomes and professional standards. To bridge the gap between innovation and responsible practice, a table of best practices is provided to support clinicians and developers in ethically integrating digital tools into psychiatric settings. These recommendations aim to uphold patient autonomy, strengthen clinician accountability, and preserve the humanistic foundation of mental health care. Ultimately, the paper advocates for a balanced and cautious approach to digitalization-one that embraces opportunity without compromising clinical integrity.