Trends in Psychiatry and Psychotherapy最新文献

Objective: Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy.

Methods: This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion.

Results: Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of -0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled.

Conclusion: We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points.

Objective: Medication non-adherence is frequently reported in patients with major depressive disorder (MDD). The objective of this review is to consolidate data on the prevalence of non-adherence to antidepressant in MDD.

Methods: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021199987. Studies assessing medication adherence in MDD were searched in PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. The data extraction was performed by two independents authors. Meta-analysis used random effects model and performed a subgroup analysis.

Results: From the articles retrieved, 11 studies were considered eligible for the final analysis. Most of them assessed non-adherence by self-report scales, followed by Pharmacy Dispensation Records, Monitoring Events Medication System (MEMS), and blood tests. The pooled proportion of non-adherence was 42% (95% confidence interval [95%CI] 30-54), but heterogeneity was very large (I² = 99%).

Conclusion: Data from the selected studies suggests that a high number of individuals with MDD do not adequately take their medication as prescribed. The high heterogenicity of measures used for the assessment of adherence may have impacted the great variability of the results. The results suggest it is necessary that health care professionals should address this issue in order to achieve a better treatment outcome in major depression.

Objective: Individuals with insomnia disorder often exhibit differences between reported experiences of sleep and objectively measured sleep parameters; however, the implications of this subjective-objective sleep discrepancy during treatment remains unclear. The aim of this study was to investigate the impact of cognitive behavioural therapy for insomnia (CBT-I) on the discrepancy between objective and subjective measures of sleep, and to assess whether changes in clinical variables such as depression, anxiety, fatigue, and beliefs about sleep, were related to changes in discrepancy.

Methods: Twenty-five participants with insomnia disorder were enrolled in group CBT-I. Sleep measures were continually sampled from baseline until 2 weeks post-treatment with both objective (i.e., actigraphy) and subjective (i.e., sleep diary) methods.

Results: The subjective-objective discrepancy significantly decreased from baseline early on in treatment (following the second session) and were maintained at post-treatment for sleep onset latency, wake after sleep onset (WASO) and sleep efficiency (SE). Total sleep time (TST) discrepancy and misperception decreased from baseline to post-treatment. Improvement in depression symptoms, fatigue symptoms, and negative beliefs about sleep were significantly correlated with the decrease in the discrepancy for WASO and SE.

Conclusion: These findings suggest that CBT-I resolves the mismatch between objective and subjective sleep parameters early in treatment for adults with insomnia. Sleep misperception improved from underestimating to accurately estimating TST. Improvement of psychological symptoms were related to decrease in sleep discrepancies across treatment. Future research is needed to explore how feedback on objective and subjective sleep discrepancy may impact sleep perception across treatment with CBT-I.

Objective: Climate change is happening and feeling anxiety can be seen as a natural response to it. Climate anxiety is worry about the climate crisis and can be related to specific emotions and thoughts. The aims of this study were to assess the prevalence of worry about climate change and describe the emotions and thoughts associated with it in Brazilian adults.

Methods: A cross-sectional study was conducted with participants aged 18-42 years (n = 323). Data were collected online using a questionnaire developed by Hickman et al., which assesses worry, thoughts, and feelings about climate change.

Results: 88.5% of the participants were worried about climate change. Those who were worried reported feelings of sadness, powerlessness, fear, and anxiety more often. The most frequent thoughts were "People have failed to take care of the planet," "The future is frightening," "My family's security will be threatened," and "Humanity is doomed."

Discussion: In this sample, the majority of the individuals were concerned about climate change and showed more negative emotions and thoughts when compared to individuals who were not concerned. Future studies should take care not to interpret natural worries and anxiety responses to climate change as pathological.

Objective: Although research has shown that mood and anxiety disorders manifest disturbed emotion regulation, it is unclear whether anxiety disorders differ from each other in terms of their emotion regulation strategies. In the present study, we investigated whether patients with anxiety disorders present different affective styles.

Methods: We assessed the affective styles of 32 obsessive-compulsive disorder (OCD) patients, 29 social anxiety disorder (SAD) patients, 29 panic disorder (PD) patients, and 20 healthy controls using the Affective Style Questionnaire (ASQ). A multivariate analysis of covariance (MANCOVA) was conducted to compare affective styles across groups (OCD, SAD, PD, and control), while controlling for depression, anxiety symptoms, and age.

Results: The MANCOVA revealed a significant, small-medium, main effect of diagnostic group on affective styles. The planned contrasts revealed that OCD and SAD patients reported significantly lower scores for "tolerance" (ASQ-T) compared to the healthy controls. There were no differences between the PD group and healthy controls.

Conclusion: Our findings provide evidence that individuals with OCD and SAD have difficulty tolerating strong emotions existing in the present moment in an open and non-defensive way.

Objectives: Death anxiety (DA) is a predictor of exacerbation of both physical and psychological symptoms of chronic diseases. Therefore, having short and easy-to-apply instruments to assess the presence of DA and adopting a multidisciplinary approach to address it are important. This study analyzes the psychometric properties of the Death Anxiety Scale (DAS), originally developed by Donald Templer, in a Colombian population of adult patients diagnosed with a chronic disease.

Methods: The original instrument was linguistically, conceptually, and culturally adapted to Colombian Spanish to be subsequently administered to 301 adult patients with chronic diseases.

Results: The exploratory factor analysis revealed a three-factor structure, which explained 47% of variance. Internal consistency was demonstrated (Cronbach's alpha: 0.71; McDonald's omega: 0.76; Guttman's lambda 6 [G6]: 0.74; greatest lower bound: 0.54). A correlation coefficient of 0.64 was found between the total score of the DAS and the Beck Anxiety Inventory (BAI).

Conclusion: When comparing the results with the versions of the DAS in Spanish from Mexico and Spain, variability in the psychometric properties was observed. Language cannot therefore be assumed to be a guarantee of the reliability and validity of the instrument.

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been linked to dysregulation in the cholinergic and endocannabinoid (EC) systems. This study systematically reviews the present literature on treatment strategies aimed at enhancing the activity of both systems in ASD models.

Methods: We performed a systematic evaluation of literatures that investigated the effects of different therapeutic interventions on the components of the cholinergic and EC systems in ASD models, following the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four databases were searched: Google Scholar, Web of science, EMBASE, and MEDLINE/PubMed, for articles published from August 2012 to February 2023. References cited in the selected research papers were also examined. Twelve papers (five on the cholinergic system, six on the EC system, and one on both) were reviewed in this study of prior work on relevant treatment strategies that impact these systems. The paper cites a total of 77 studies.

Results: The majority of research revealed that different therapeutic interventions downregulated cannabinoid 1 (CB1) receptors, and the system's hydrolyzing enzymes and upregulated EC, alpha 7 nicotinic acetylcholine receptor (α7-nAChR), and ACh signaling molecules. Regulation of the components of the cholinergic and EC systems by these therapies generally enhanced behaviors in ASD models.

Conclusion: It is possible that the therapeutic interventions assessed in one or both of these systems may be effective for treating the core ASD-associated phenotype. The benefits of the therapeutic interventions reviewed in this study merit further investigation in randomized, blinded, placebo-controlled clinical trials.

The state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress, known as burnout syndrome (BS), is not only affecting the medical workforce but medical students in training. Gender, race, ethnicity, and potentially other variables can serve as significant risk factors contributing to BS among medical students. Despite the importance of understanding these disparities, very few studies in the U.S. have analyzed race or ethnicity amongst their cohorts. However, there exists extensive information on burnout in students from Latin America, which serves as the primary focus of this review. A systematic literature search was conducted using pertinent terms in English and Spanish. Our review found that the prevalence of BS in Latin American countries varies widely, ranging from 4.3 to 43.90% pre-COVID-19 pandemic. Variability in the educational environment and the complex interplay of cultural, academic, and systemic factors appear to contributing to burnout among students. Post-pandemic investigations reveal even higher prevalences, particularly among women. High rates of depression and anxiety are also reported during the COVID-19 pandemic. The reviewed data showed that BS can become further exacerbated and complicated by existing psychiatric comorbidities amongst Latin American medical students. It is possible that we may observe continued upward trajectories in burnout trends among both healthcare workers and medical students in this post-COVID-19 pandemic era. These insights call for tailored interventions addressing not only burnout but also the interconnected mental health challenges faced by medical students in Latin America.

Objective: Approximately 6 to 13% of women suffer from antenatal depression (AD) around the world. AD can lead to several health problems for mother and baby. Vitamin D is a molecule that appears to have great preventive/therapeutic potential against neuropsychiatric disorders. The present study aimed to analyze the association between vitamin D deficiency and AD in pregnant women in a city in the south of Brazil (Pelotas, Rio Grande do Sul). We hypothesize that pregnant women with a positive AD diagnosis have deficient levels of 25-hydroxyvitamin D (25(OH)D).

Methods: This cross-sectional study was conducted within a cohort study (CEP/UCPEL 47807915.4.0000.5339). From this cohort, 180 pregnant women at up to 24 weeks gestation were selected (130 non-depressed and 50 depressed), and depression was diagnosed using the Mini International Neuropsychiatric Interview (MINI-Plus). Blood was collected and stored for later analysis of vitamin D 25(OH)D by the chemiluminescence method. The SPSS program was used for data analysis and results with p < 0.05 were considered statistically significant.

Results: In our study, we showed a significant association between current major depressive episode in the antenatal period and vitamin D deficiency (odds ratio [OR]: 0.9; 95%CI 0.9-1.0, p = 0.003).

Conclusion: Our results demonstrate that vitamin D deficiency may be involved in major depressive disorder in the antenatal period. It is thus advisable to monitor vitamin D levels during the pregnancy-puerperal cycle to minimize mental health problems in women and prevent developmental deficits in children.

Objective: Incarcerated individuals exhibit higher suicide rates compared to the general population. Investigating risk factors aids in developing effective public policies and interventions. The goal of this study was to assess and analyze factors predicting both suicidal thoughts and suicide attempts in a population of male incarcerated individuals who engage in the use of multiple psychoactive substances.

Methods: A cross-sectional observational study was conducted. A total of 174 male individuals deprived of liberty participated in the study, all of whom were serving a closed prison sentence during the data collection steps. Participants were assessed with the following instruments: the Addiction Severity Index (ASI-6) and the Barratt Impulsiveness Scale (BIS-11).

Results: Amongst our sample, observed prevalences were 36.7% for suicidal ideation and 16% for suicide attempts. Impulsivity (odds ratio [OR] = 1.098, 95% confidence interval [95%CI] 1.008-1.197), social support (OR = 0.281, 95%CI 0.085-0.925), witnessing someone being killed or beaten (OR = 5.173, 95%CI 2.143-12.486), cigarette use (OR = 3.309, 95%CI 1.063-10.293), and cocaine use (OR = 2.678, 95%CI 1.040-6.897) were found to be associated with suicidal ideation. No significant associations were found between drug use and suicide attempts.

Conclusion: A high prevalence of suicidal behaviors was observed among the study sample, with findings demonstrating that impulsivity moderately differentiates between the groups "with" and "without" suicidal ideation. Traumatic life events and substance use were also associated with suicide ideation, while social support was established as a protective factor against it.