Clinical Neuropsychiatry最新文献

Objective: To assess the prevalence of poor sleep quality and identify associated factors among patients with systemic lupus erythematosus (SLE).

Method: A cross-sectional study was conducted at Bach Mai Hospital, Vietnam, from January 2024 to December 2024. Adult SLE patients meeting the ACR/EULAR 2019 classification criteria were consecutively enrolled. Data were collected on sociodemographic, clinical, behavioral, and psychological characteristics. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with a global score >5 indicating poor sleep. Depression and anxiety were measured using the Beck Depression Inventory-II (BDI-II) and Hamilton Anxiety Rating Scale (HAM-A), respectively. Multivariate logistic and Tobit regression analyses were performed to identify factors associated with poor sleep quality and PSQI score.

Results: A total of 453 SLE patients participated, of whom 66.7% exhibited poor sleep quality. In multivariate regression, poor sleep quality was independently associated with older age (OR: 1.05, 95% CI: 1.02-1.07), higher disease activity (SLEDAI; OR: 1.04, 95% CI: 1.01-1.06), greater organ damage (SLICC/ACR index; OR: 1.17, 95% CI: 1.02-1.34), and higher anxiety severity (mild: OR 2.51, moderate: OR 3.53). Alcohol use (OR: 0.24, 95% CI: 0.07-0.90) and opioid use (OR: 0.08, 95% CI: 0.01-0.99) were associated with lower odds of poor sleep quality. For PSQI score, worse sleep quality was significantly associated with older age (Coef.: 0.09, 95% CI: 0.06-0.11), more frequent lupus flares (2 episodes: Coef. 1.14; ≥3 episodes: Coef. 1.76), and higher anxiety severity (mild: 1.82; moderate: 2.34; severe: 3.99).

Conclusions: Multidisciplinary approaches targeting psychological well-being, disease control, and healthy lifestyle behaviors are essential to improve sleep and quality of life in this population.

Thirty-nine highly acknowledged experts in the areas of the physiology and the evolution of the vagus nerve and of vertebrate social behavior (many whose works have been cited in the polyvagal theory [PVT] literature as supporting the theory) were invited by the first author to participate as co-authors of this article. They were asked to evaluate the PVT and comment upon an overview of the theory written by its author (Porges, 2025a). All those invited, save one, accepted and co-authored the paper. The dissenting scholar was "unfamiliar with the PVT." This article specifically appraises--based upon the current state of knowledge of autonomic function and vertebrate evolution--several major elements of the PVT, as described in Porges (2025a) and elsewhere. These include: 1) the validity of PVT assumptions that respiratory sinus arrhythmia is a direct measure of the extent of central vagal drive to the heart; 2) PVT characterizations regarding the neuroanatomy and functions of two major brainstem vagal nuclei, the ventrally situated Nucleus Ambiguus and the Dorsal Motor Nucleus of the vagus nerve; 3) PVT assertions regarding the evolution of the vagus nerve; 4) PVT claims about the specificity of mammalian social behavior in relation to nonmammalian vertebrates, and 5) PVT interpretations of earlier seminal physiological literature. All co-authors agree that major tenets of the PVT are not supported by past or current knowledge and, in several instances, are inconsistent with the broader evidence base. Since the topics addressed constitute fundamental premises of the PVT, we conclude that the PVT is untenable, because it is not defensible based on existing neurophysiological and evolutionary evidence. The psychological elements composing the superstructure of the PVT are primarily derived from earlier psychological literature and are neither clarified nor strengthened by PVT constructs that lack evidence. This article does not intend to address alternative explanations about relations between vagal function and psychological processes, although such explanations do exist.

Objective: This study assessed smartphone addiction, internet addiction, eHealth literacy, social support, loneliness, depression, and sleep quality among health sciences students, and examined their structural relationships using structural equation modeling (SEM).

Method: A cross-sectional survey was conducted among 447 Medicine, Nursing, and Pharmacy students at a university in Hanoi. Data were collected using a self-administered paper questionnaire incorporating validated instruments: SAS-SV, IAT-6, eHEALS, DUFSSQ-8, UCLA-3, PHQ-9, and B-PSQI. Descriptive statistics, correlation analyses, and SEM were performed using Stata 17 and SmartPLS 3.0.

Results: Participants reported moderate levels of smartphone addiction (35.7 ± 8.9) and internet addiction (13.1 ± 4.8). Internet addiction demonstrated direct effects on higher depression (β = 0.36, p < 0.001), poorer sleep quality (β = 0.27, p < 0.001), and lower social support (β = -0.25, p < 0.001). Smartphone addiction was positively associated with eHealth literacy (β = 0.21, p < 0.001) and loneliness (β = 0.16, p = 0.003). Social support showed strong inverse associations with depression, loneliness, and poor sleep, and mediated the effects of internet addiction on all three outcomes. eHealth literacy did not attenuate adverse effects.

Conclusions: Among Vietnamese health science students, problematic smartphone and internet use is associated with greater loneliness, depressive symptoms, and sleep disturbances. Enhancing social support ‒ rather than relying solely on eHealth literacy ‒ appears critical to reducing these harms. Universities should implement strategies that foster digital well-being, limit problematic technology use, and strengthen peer connectedness and supportive campus environments.

Objective: Adolescence is a vulnerable phase of life, especially in relation to the development of personal identity. Researchers and clinicians must pay close attention to how the perception of time, the organization of events and information into a coherent narrative, and the development of self-representations unfold during this period of life. Aim of the present review is to summarize the research evidence about narrative identity development in healthy adolescents and discuss this in the framework of contemporary socio-cultural changes.

Method: Conducted as a scoping review following the PRISMA-ScR guidelines, a literature search was performed in PubMed without predefined restrictions. Eligibility criteria included original human studies in English, involving non-clinical participants aged 11-22 years. Twenty-six studies met inclusion criteria and were analyzed regarding narrative coherence, narrative self-awareness, and developmental trajectories.

Results: Among the included studies we identified two main areas of investigation, that are narrative coherence and narrative self-awareness. Studies about narrative coherence generally show an age-related increase. Narrative self-awareness development was found to be related to the influence of the environment and to psychological well-being from adolescents to adulthood.

Conclusions: Anomalies of narrative identity have been studied in psychopathological contexts but are understudied in healthy adolescents. Given that narrative identity development is influenced by the environment, and in light of rapid socio-cultural changes (e.g., digitalization and episodic temporal modes), more research is needed to explore how contemporary conditions affect identity construction in adolescents. The findings highlight developmental patterns in narrative identity that reflect both maturational processes and socio-cultural influences. Refining our understanding of these dynamics can guide future longitudinal studies and inform identity-focused interventions in adolescent mental health.

Objective: Antisocial personality disorder (ASPD) is characterized by a pattern of negligence towards social norms, illicit and aggressive conduct, and lack of remorse. Adverse Childhood Experiences (ACEs) and subsequent development of Early Maladaptive Schemas (EMS) play a significant role in psychopathology vulnerability, including personality disorders. However, the evidence on the link between cognitive and environmental vulnerability in ASPD specifically is still limited. The aim of the present review is to analyze and discuss the available literature exploring the role of specific ACEs and EMSs in the development of ASPD and investigate the possible mediating role of cognitive variables between environmental factors and ASPD.

Method: A systematic analysis was conducted of records published from January 1st, 2002 to March 18th, 2025 on APAJournals, MEDLINE, Google Scholar, PubMed, using keywords pertaining to three concepts: "antisocial personality disorder", "early maladaptive schema/schema mode", "adverse childhood experiences".

Results: A total of 7719 records were screened, while 229 records were analyzed against our eligibility criteria, resulting in the inclusion of 26 records. The studies emphasize the contribution of physical abuse, and Disconnection/Rejection and Impaired limits domains in the etiology of ASPD. Regarding the mediation between ACEs and ASPD, various studies focused on dysfunctional schema-modes, finding that Child, Over-compensatory, and Healthy Adult modes play a role in ASPD, highlighting the relevance of maladaptive coping and rapid emotional fluctuation in the disorder.

Conclusions: The results enhance our understanding of the contribution of ACEs and EMS in the development of ASPD; however, evidence of a link between cognitive and environmental variables in the development of the disorder is scarce and heterogeneous. Going forward, studies should particularly investigate environmental and cognitive vulnerability to promote a greater understanding of ASPD functioning and tailor clinical interventions based on specific hyper-invested goals and the learned maladaptive coping strategies to pursue them.

Objective: Bullying is a serious problem among school-age children, contributing to both internalizing and externalizing difficulties. The existing literature does not place much emphasis on the factors explaining the link between victimization and psychological difficulties. This study looked into the roles of rumination and self-efficacy in this relationship.

Method: Data was collected from 362 children (202 girls; Mage = 13.1, SD = 1.16) over two points in time, separated by 6 months.

Results: Findings revealed a main effect of bullying status (being a victim of bullying vs. being non-involved) on rumination, self-efficacy, and internalizing/externalizing symptoms. Additional analyses explored different existing profiles (non-involved who stayed non-involved, new victims, escaped victims, and continuous victims) in terms of their psychological difficulties, ruminative responses, and self-efficacy. Mediation analyses show that victimization at Time 1 predicts internalizing difficulties at Time 2, but this effect is not mediated by rumination or self-efficacy. Conversely, victimization indirectly predicts externalizing symptoms at Time 2 via rumination. Moreover, internalizing symptoms at Time 1 predict victimization at Time 2 through both rumination and self-efficacy, while externalizing symptoms at Time 1 predict victimization at Time 2 via self-efficacy.

Conclusions: The findings provide practical insights for those working with victims of bullying and also lay the foundation for future research.

Objective: Cognitive impairment is a growing public health concern among aging populations, yet evidence from Vietnam remains limited. This study aimed to assess the prevalence of cognitive impairment among older adults in Hanoi and identify demographic, socioeconomic, lifestyle, and health-related determinants.

Method: A cross-sectional study was conducted among 763 adults aged ≥60 years from one urban ward and one rural commune in Hanoi (June-December 2023). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with impairment classified into mild, moderate, and severe levels. Mental health, anxiety, and sleep quality were measured using the PHQ-9, GAD-7, and PSQI. Multivariate logistic regression with stepwise forward selection identified independent predictors of cognitive impairment.

Results: Cognitive impairment was highly prevalent, affecting 70.4% of participants (46.1% mild, 19.3% moderate, 5.0% severe). Mean MoCA score was 21.3 (SD=6.3). Age was the strongest predictor (OR=1.11 per year, 95% CI: 1.08-1.15). Female gender (OR=1.63, 95% CI: 1.09-2.44), lower education (OR=0.58 for >high school vs

Conclusions: Cognitive impairment is widespread among older adults in Hanoi and is shaped by demographic, socioeconomic, and modifiable health factors. Interventions to promote physical activity, mental health, and economic security, alongside improved access to screening and elder care in rural areas, are essential for supporting healthy cognitive aging in Vietnam.

Objective: Neuromuscular disorders (NMD) are rare, chronic diseases affecting muscle and nerve function, leading to motor, cognitive, and socio-emotional challenges. While physical and cognitive aspects have been widely studied, socio-emotional functioning remains underexplored. This study assessed the feasibility of using invented oral stories to examine internal state language in children with NMD compared to typically developing peers.

Method: Forty 5-12 years old children (20 with NMD, 20 typically developing) spontaneously narrated fictional stories, analyzed for structure, cohesion, and psychological lexicon that refers to words expressing internal mental and emotional states.

Results: Results showed no significant differences in narrative structure or cohesion, supporting the feasibility of oral storytelling. However, children with NMD used more physiological and socio-relational terms, emphasizing their attention to bodily experiences and social interactions as coping strategies.

Conclusions: These findings highlight oral narratives as a valuable tool to access socio-emotional development in children with NMD through narrative-based interventions.

Objective: This study aims to explore the interplay between pathological narcissism, reflective functioning (RF), and peer exclusion (vs. inclusion) among adolescents. The study hypothesizes that peer exclusion (vs. inclusion) is associated with greater post-task difficulties in reflective functioning and higher rejection-related emotions, and tests whether these associations vary as a function of pathological narcissism.

Method: A sample of 204 adolescents (aged 14-18) participated in an experimental task simulating social media interactions using the Social Media Ostracism Paradigm (SMOP). Participants were assigned to one of three experimental conditions: Over-Inclusion (OI), Neutral (N), and Over-Exclusion (OE). Pathological narcissism was assessed using the Pathological Narcissism Inventory (PNI), and reflective functioning and rejection-related emotions were evaluated post-task.

Results: High-risk narcissistic adolescents exhibited significantly lower RF scores than their low-risk peers (F(1, 198) = 13.72, p < .001), particularly in the OE condition (F(2, 198) = 6.76, p < .001). Low-risk adolescents in the OI condition demonstrated better RF. Social exclusion significantly impacted rejection-related emotions (F(2, 198) = 13.890, p < .001), with OE participants reporting higher distress than N and OI groups. However, narcissism did not significantly moderate emotional responses.

Conclusions: Pathological narcissism was associated with greater RF difficulties, which were most evident under exclusion. However, rejection distress appears to be a broadly shared response in adolescence and may function as a normative signal of threatened belongingness, relatively independent of narcissism levels. These results emphasize the importance of targeted interventions focusing on mentalization and peer dynamics, particularly for adolescents with high-risk narcissism traits.

A recent critique advanced by Grossman et al. (2026, this issue) argues that Polyvagal Theory is scientifically untenable, asserting that its core claims regarding autonomic organization, respiratory sinus arrhythmia (RSA), and evolutionary framing are inconsistent with established neurophysiology. The present paper evaluates these assertions not by disputing individual claims in isolation, but by examining whether the critique engages Polyvagal Theory as it is articulated in the peer-reviewed literature and whether it meets the epistemic standards required for scientific refutation. Rather than responding sequentially to individual objections, the analysis clarifies the theory's conceptual foundations, scope, and explicit conditions of falsifiability as a systems-level, pathway-specific framework of autonomic state regulation. It demonstrates that the critique repeatedly evaluates a reconstructed proxy of the theory shaped by persistent category errors, including conflation of neuroanatomy with neurophysiology, reduction of theory to measurement, and substitution of phylogenetic continuity for functional organization. These structural misrepresentations propagate across methodological, neurophysiological, evolutionary, and developmental domains, precluding meaningful empirical adjudication. Across these domains, the paper shows that disagreements concerning RSA metrics, comparative anatomy, or evolutionary framing do not engage the theory's specified mechanisms or demonstrate conditions under which its predictions would fail. Where disagreement exists, it reflects differences in measurement preference, level of analysis, or theoretical framing rather than evidence against the theory's organizing principles. An appendix presents a historical audit showing that several central claims reiterated in the critique were identified in the literature nearly two decades earlier as mischaracterizations of Polyvagal Theory. Their continued repetition without substantive modification reflects a persistent failure of representational uptake rather than unresolved empirical controversy. It is concluded that the charge of scientific untenability does not apply to Polyvagal Theory as formulated, but instead reflects a critique that fails to engage the theory on its own terms. Productive scientific discourse requires representational fidelity, appropriate alignment of levels of analysis, and responsiveness to theoretical and empirical clarification ‒ criteria essential to theory evaluation but not met in the critique under review.