NEUROPSYCHIATRIE最新文献

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.

Background: Severe postpartum mental illnesses (PPSMI), including postpartum psychosis, bipolar disorder, and major depression, affect approximately 1-2 per 1000 deliveries and can lead to serious consequences including suicide, infanticide, and long-term disruptions in the mother-infant relationship. In many low-resource settings, the absence of specialized mother-baby units (MBUs) necessitates alternate models of care.

Methods: This narrative review synthesizes current evidence and clinical guidelines on managing PPMI in outpatient and inpatient settings. Key focus areas include rational psychopharmacology, indications for electroconvulsive therapy (ECT), identification of organic conditions, psychosocial interventions, and family involvement, particularly in low- and middle-income countries (LMICs).

Results: Effective management of PPSMI requires timely diagnosis, individualized medication plans compatible with breastfeeding, and consideration of conditions such as autoimmune encephalitis or cerebral venous thrombosis in atypical presentations. ECT is a valuable, often underutilized, option. Multidisciplinary teams play a key role in psychiatric evaluation, pharmacological and nonpharmacological treatment. Family engagement, telepsychosocial support, caregiver education, safety planning and community-based care are essential in the absence of MBUs.

Conclusion: A multidisciplinary, biopsychosocial approach adapted to local resources is vital for managing PPSMI. Strengthening perinatal mental health services and policies can improve maternal outcomes and ensure safer environments for both mother and infant.

The future of psychiatry depends upon the development of knowledge about the functioning of the brain and the human body, on the changes to the world in which we live, and on the impact of major socioeconomic trends such as urbanization. This article describes the impact of these trends on mental health and health programs and lists what should be done to reduce mental health problems and improve the future of psychiatry.

Physical exercise has been proposed as an adjunctive treatment for schizophrenia spectrum disorders, with meta-analyses showing benefits for positive, negative, and total symptom severity, as well as cognition and daily functioning, although effects on physical health remain minimal. This narrative review summarizes current evidence, discusses the underlying mechanisms, and offers recommendations for implementing exercise therapy in clinical practice.

Mental disorders are often associated with a significantly reduced level of physical activity, leading to inactivity rates of 40-86%. This is concerning, as physical activity not only has well-documented positive effects on physical health but also represents an evidence-based, cost-effective, and low-risk treatment option for psychiatric disorders. However, exercise remains insufficiently integrated into psychiatric care, partly due to barriers among healthcare providers and patients. The most common barriers reported by patients include fatigue, uncertainty, and financial constraints, while lack of time plays a less significant role.This review examines the scientific evidence supporting exercise as a therapeutic intervention - "Exercise is Medicine®" - for psychiatric disorders and highlights its effectiveness across a wide range of conditions, from anxiety disorders to obsessive-compulsive disorders. Furthermore, it explores the "knowledge-action gap" between existing research and clinical implementation, providing practical recommendations based on Motivational Interviewing techniques. In addition to distinguishing between the concepts of physical activity, exercise, sport, and exercise therapy, this article presents recommendations for physical activity, behavior change techniques, a structured counseling guide, and an informational flyer for patients.The aim of this article is to establish exercise as an integral component of psychiatric treatment and facilitate its implementation in clinical practice. By integrating physical activity, not only can quality of life and mental health be improved, but health disparities can also be reduced. This article offers evidence-based recommendations and practical strategies for promoting physical activity in psychiatric care.

Purpose: This study explored the feasibility and therapeutic potential of combining artificial intelligence (AI)-assisted visual elicitation with sensory-attuned guided reflection to support emotional expression and engagement in individuals with anorexia nervosa (AN).

Methods: We conducted a two-session, therapist-led intervention with two adults with restrictive AN. In session 1, we guided participants to reflect on emotionally challenging experiences using metaphor and sensory language cues. We translated these narratives into prompts for DALL·E (v3; OpenAI, San Francisco, CA, USA), an AI image-generation tool. In session 2, participants selected from curated images to reflect on and deepen their exploration of emotional experiences. We analysed the data using reflexive thematic analysis and performed a cross-case synthesis.

Results: Visual metaphors helped to externalise and communicate emotions, evoke embodied responses and refine affective descriptions. The co-creative process fostered therapeutic engagement and a greater sense of agency in both participants.

Conclusion: AI-assisted visual elicitation, integrated into a structured therapeutic process, may offer an additional benefit to talking therapy for individuals with AN. By enabling visual expression, this approach could support emotional insight and communication in populations with emotion labelling and regulation differences.

Mental health conditions (MHCs) account for a large proportion of global disease burden and result in broad impacts and associated economic costs. Despite the existence of effective public mental health (PMH) interventions, only a minority of individuals with MHCs receive treatment, far fewer receive interventions to prevent associated impacts, and there is negligible coverage of interventions to prevent MHCs or promote mental wellbeing and resilience. This implementation failure results in population-scale preventable suffering, broad impacts and associated economic costs, which are far greater in low- and middle-income countries. The gap also breaches the right to health and statutory legislation in some countries. The World Psychiatric Association has prioritised PMH and highlighted how a set of coordinated actions can improve PMH implementation, including by effectively making the PMH case, PMH practice, PMH training and improved population knowledge, settings-based and integrated approaches, digital technology, maximising existing resources, use of interventions with a large population impact, a rights approach and legislation, and implementation-focused research. Improved implementation results in broad population impacts, achievement of policy objectives across sectors and sustainable reduction in the impact of MHCs and promotion of population wellbeing. The associated economic benefits make PMH a key part of sustainable economic development.