NEUROPSYCHIATRIE最新文献

Background: Variegate porphyria (VP) is a rare metabolic disorder resulting in a deficiency of the heme synthesis pathway. Patients typically present with photosensitive skin lesions, hypertension, abdominal pain, and heterogeneous neuropsychiatric symptoms, including psychosis.

Methods: We report a case of porphyria-associated psychosis in a female patient with VP and no prior psychiatric history. Additionally, we highlight the hypothesized underlying pathophysiological mechanisms contributing to neuropsychiatric symptoms in VP.

Results: Although VP is a rare cause of psychosis, its pathophysiological mechanisms are of significant interest, as they further support the plausibility of current prevailing hypotheses on the development of psychosis.

Conclusion: Management of VP requires care in specialized centers. Avoiding triggers, such as stress, fasting, and certain medications, is crucial for preventing disease flare-ups.

Background: Treating patients with anorexia nervosa (AN) is generally prolonged or often ineffective. A key factor influencing treatment is the high level of ambivalence patients feel regarding the necessary behavioral changes. We examined the trajectories of patients' readiness to change throughout their inpatient stay, considering the influence of their illness perceptions.

Methods: Data from clinical routine monitoring at the Department of Psychosomatic Medicine at Medical University Innsbruck, collected between 2015 and 2024, were analyzed. Monitoring included questionnaires assessing readiness to change (Fragebogen zur Erfassung der Veränderungsbereitschaft [FEVER], biweekly) and the patients' individual perception of illness (Brief Illness Perception Questionnaire [B-IPQ], weekly). Data analysis was conducted using linear mixed models, considering data from 189 adult patients (2321 data points) diagnosed with AN or atypical AN (F 50.0, F 50.1; 94.9% female; average length of hospital stay 5.3 weeks).

Results: Willingness to change shifted during treatment, with lower precontemplation and higher action scores at discharge. In linear mixed-effects models, higher perceived treatment control, illness concern, and consequences were significantly associated with more advanced stages of change.

Conclusion: The results indicate that an individual's perception of their illness influences their readiness to change. This underscores the importance of continuously integrating patients' perceptions into treatment and collaboratively addressing their assumptions and beliefs.

This systematic review examines the connections between eating disorders, body image disturbance, self-esteem, and emotion regulation in adults. Following the PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science databases was conducted for articles published between 2010 and June 2024. Studies were included if they involved participants aged 18 years and older, employed validated tools for measuring the variables, and presented original research that specifically addressed these psychological factors. Out of 1117 records, six studies met the inclusion criteria, with mostly female samples and a focus on body image, self-esteem, and emotion regulation in relation to eating disorders. The results indicate that body dissatisfaction is closely related to disordered eating behaviors, with a significant link to lower self-esteem and difficulties in emotion regulation. Obese individuals with binge eating disorder (BED) were found to have more negative attitudes toward obesity and greater levels of depression than their non-BED counterparts. Women with bulimia nervosa showed higher emotion-focused coping, which is associated with low self-worth. Differences in gender were evident, with women exhibiting greater vulnerability to body image dissatisfaction and emotion dysregulation. The results show that treatment for adults with eating disorders should focus on the enhancement of self-esteem, the improvement of body image perception, and the development of adaptive emotion regulation strategies. Lastly, practicing self-compassion techniques in psychotherapy could improve the treatment process for patients suffering from eating disorders, low self-esteem, emotion dysregulation, and body image disturbance. Future studies should investigate these variables in various non-Western cultural contexts for better understanding and clinical intervention for the adult population.

Background: The potential causal relationship between gastroesophageal reflux disease (GERD) and mental disorder was analyzed using the mendelian randomization (MR) method.

Methods: Data are derived from genome-wide association study (GWAS) summary data, using gastroesophageal reflux disease (GERD) as the exposure factor. Single nucleotide polymorphisms (SNPs) significantly associated with GERD were selected as instrumental variables (IVs), and mental disorders (bipolar disorder, major depression, Alzheimer's disease, anorexia nervosa, anxiety, and obsessive-compulsive disorder) were used as outcome variables. The inverse variance weighted (IVW) method is used as the main analysis method, and MR-Egger regression, weighted median (WM) method, simple mode and weighted mode are used as supplementary methods for Mendelian randomization (MR) analysis. Cochran's Q test and P value are used to quantify heterogeneity, MR-Egger regression was used to evaluate the multilevel effect test of SNPs, and leave-one-out method to determine whether there are potential SNPs, and to evaluate the stability of the results. Odds ratio (OR) and 95% confidence interval (CI) were used as effect indicators to evaluate whether there is a causal relationship between GERD and mental disorders.

Results: IVW demonstrated a causal relationship between GERD and bipolar disorder (OR = 1.70, 95%CI = 1.39-2.09, P < 0.05) and anorexia nervosa (OR = 0.71, 95%CI = 0.52-0.99, P < 0.05). Furthermore, there is a weak causal relationship between GERD and major depression (OR = 1.01, 95%CI = 1.01-1.02, P < 0.05) and anxiety (OR = 1.01, 95%CI = 1.01-1.01, P < 0.05). Similarly, there is no evidence of a causal relationship between GERD and Alzheimer's disease (OR = 0.95, 95%CI = 0.87-1.03, P > 0.05) or obsessive-compulsive disorder (OR = 0.95, 95%CI = 0.67-1.36, P > 0.05). Cochran's Q test for heterogeneity shows that there is no significant heterogeneity (P > 0.05) for bipolar disorder, anxiety, and obsessive-compulsive disorder. However, major depression, Alzheimer's disease, and anorexia nervosa have some degree of heterogeneity (P < 0.05). Horizontal pleiotropic analysis showed that the P values for six mental disorders (0.750, 0.296, 0.154, 0.798, 0.893, 0.451) were all greater than 0.05. Leave-one-out analysis and funnel plot showed that MR analysis results can be considered relatively stable. All F are > 10, indicating no weak IVs bias.

Conclusion: GERD can obviously increase the risk of bipolar disorder; the increased risk of anxiety disorder is very slight. There is no clear evidence to support the causal relationship between GERD and four other mental disorders, including major depression, Alzheimer's disease, anorexia nervosa, and obsessive-compulsive disorder.

Severe mental disorders, particularly schizophrenia and related disorders, remain among the most disabling and costly health conditions worldwide. Despite advances in pharmacological and psychosocial treatments, recovery rates remain low. Early intervention has emerged as a key strategy to improve outcomes. Reducing the duration of untreated psychosis (DUP) and providing specialized early intervention services-such as Denmark's OPUS, the UK's LEO, and the US Recovery After an Initial Schizophrenia Episode (RAISE) trial-have shown significant benefits in symptom reduction, functioning, and cost-effectiveness. Assertive Community Treatment (ACT), Individual Placement and Support (IPS), and Housing First programs further enhance recovery for individuals with complex needs, including comorbid substance use and homelessness. Innovative therapies, such as avatar-based treatment for persistent hallucinations, show promise in treatment-resistant cases. Children of parents with severe mental illness are at elevated risk and offer a unique opportunity for prevention. The Danish High Risk and Resilience Study (VIA 7), which follows high-risk children from age 7 to 19, exemplifies how longitudinal research can identify early modifiable risk factors and inform timely interventions. To improve long-term outcomes, services must be coordinated, person-centered, and recovery-oriented-delivering care that is accessible, humane, and tailored to the individual's stage of illness and life circumstances.

The World Psychiatric Association (WPA) is dedicated to advancing mental health through evidence-based and inclusive initiatives. Its 2023-2026 Action Plan emphasizes prevention, early intervention, and comprehensive care, aligned with the United Nations 17 Sustainable Development Goals to address broader social determinants of mental health. An important focus of the Action Plan is promoting healthy lifestyles as a fundamental component of mental well-being. Through the Healthy Lifestyle Hub, the WPA promotes the benefits of physical activity, good nutrition, and sleep hygiene in preventing and managing mental health conditions. Complementing these efforts, the Specialist Corner, through dissemination of scientific advances and their clinical applications, facilitates knowledge exchange among clinicians, researchers, and policymakers, while the WHO Brief Motivational Intervention and Contact program (BIC), comprising long-erm regular follow-up of suicide attempters after hospital discharge, enhances suicide prevention. Guided by the EDIT principle-Equality across genders, ages, and ethnicities; Developmental stages from childhood to adulthood and beyond; Inclusion; and Transcultural awareness-the WPA ensures that mental health strategies are inclusive, equitable, and culturally responsive. By integrating scientific advancements with lifestyle-based interventions, the WPA Action Plan serves as a framework for global psychiatry, advocating sustainable and comprehensive approaches to mental well-being.

Stigma and discrimination related to mental health are major global challenges that demand urgent, evidence-based responses. The Mosaic Toolkit to End Stigma and Discrimination was developed in response to calls for practical guidance to end stigma and discrimination. This article outlines the co-production process behind the toolkit's creation, carried out from December 2022 to August 2024, through a collaboration between World Health Organization (WHO) Regional Office for Europe, the Global Mental Health Peer Network, and King's College London. The development involved extensive consultation with individuals with lived experience and a wide range of stakeholders, ensuring cultural relevance, inclusivity, and applicability in diverse settings. The toolkit outlines core principles for stigma reduction, an action-oriented process model, illustrative case studies, and supportive resources including advocacy tools. Grounded in the principle of "nothing about us without us" and the power of social contact, the practical strategies within the WHO Mosaic Toolkit offers a concrete path to ending mental health stigma. The next crucial step will involve supporting implementation in real-world contexts to create lasting change. Designed for global application, the toolkit aims to foster dignity, inclusion, and rights-based approaches to end mental health stigma and discrimination.