Clinical Neuropsychiatry最新文献

Objective: skin-picking behaviors are often maintained in association with mood changes, but can also manifest as separate manifestations particularly in Alzheimer's disease (AD). Verifying the effect of interventions on its remission may contribute to reducing stress in patients and caregivers. This systematic review sought to evaluate the eficacy of pharmacological interventions for skin-picking behaviors in elderly individuals with AD.

Method: according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020), searches were conducted in ClinicalTrials.gov,Embase, Lilacs, Open Science Framework, PsycNET, PubMed, Scopus, SciELO, SciELO Preprints and Web of Science, with no language or date restrictions. Inclusion criteria were clinical trials with participants aged ≥ 40 years with AD, evaluating pre/ post-test outcomes with standardized instruments.

Results: of the 87 records found, none met the eligibility criteria, configuring an empty review. Two studies related to the topic were excluded because they were not clinical trials (a single case report and a case series), involving five patients treated with antipsychotics (risperidone, pimozide and thioridazine) and antidepressants (paroxetine). The absence of eligible studies suggests a gap in the literature and the lack of robust evidence on the pharmacological efficacy on these behavioral symptoms in this population.

Conclusions: future clinical trials are needed to support specific therapeutic recommendations, since the evidence suggested by studies that are not clinical trials, evaluated in addition to the main objective of this review, is primary and limited.

Objective: the main objective of present research project was to develop and validate a neuropsychological test assessment battery to evaluate the neuropsychological profiles of healthy and clinical populations from Pakistani.

Method: the battery was developed in two languages, URDU and non-native English, to assess neuropsychological functioning of illiterate to highly literate Urdu Speaking and bilingual Pakistani populations. It was named as Pakistani Neuropsychological Test Assessment Battery (PANATB). The PANTAB assessed neuropsychological functioning from six domains namely orientation, attention and concentration, language, visuo-spatial & perceptual ability, memory, and executive functions. It included items most relevant to Pakistani norms and culture. Its administration time is 35 to 40 minutes. The project was completed in two phases of development and validation. Validation was done in two studies.

Results: the first study evaluated and established the retest reliability and concurrent validity on a sample of adolescents and adults (n1=216). Age and educational differences were also observed in performance. Clinical and convergent validities were established in the second study (n=122) by comparing the performance of two clinical subgroups of patients with traumatic brain injury and stroke with healthy participants.

Conclusions: the PANTAB is a valid measure of neuropsychological assessment and is sensitive to identifying cognitive impairment associated with clinical conditions and aging. It may fulfill the need for brief, reliable, and objective evaluation of a broad range of neurocognitive functions in the Pakistani clinical and non-clinical populations.

Objective: this study aimed to provide preliminary validity evidence for an 8-item short form of the Climate Change Anxiety Scale (CCAS-SF) in a sample of Italian emerging adults. Specifically, it tested the factor structure, measurement invariance across sex, and construct validity of the CCAS-SF.

Method: the study involved 891 Italian emerging adults (32.40% male; Mage = 23.00, SD = 2.50; age range: 19-29 years). The researchers conducted a Confirmatory Factor Analysis (CFA) to evaluate the factor structure of the CCAS-SF. Measurement invariance across sex was tested through configural, metric, and scalar invariance. Internal consistency of the subscales was assessed, and correlations with anxiety and depression symptoms were examined to assess construct validity.

Results: the CFA supported a two-factor structure for the CCAS-SF, cognitive-emotional and functional impairment. Measurement invariance was confirmed across sex (configural, metric, and scalar invariance). The internal consistency of both subscales was good. Analysis revealed that females had higher levels of cognitive-emotional impairment compared to males, but there were no significant sex differences in functional impairment. Both subscales showed positive correlations with anxiety and depression symptoms.

Conclusions: the Italian CCAS-SF is a brief, valid, and reliable tool for assessing climate change anxiety. It is particularly useful for time-constrained research and as a resource for mental health professionals working with emerging adults.

Objective: High cardiovascular risk (i.e., increased heart rate (HR) and reduced HR variability (HRV)) is common among healthcare workers. HRV biofeedback (HRVB) and cardiac coherence training (CCT) aim to minimize cardiac reactivity through breathing and cognitive exercises. Despite the numerous evidence, there are no studies that have investigated the potential role of psychological and psychophysiological factors on its efficacy.

Method: Twenty healthcare workers (i.e., doctors, nurses, psychologists, etc.) employed at the San Giacomo Hospital of Physical Medicine and Rehabilitation in Ponte dell'Olio (Piacenza, Italy) completed the Symptom Checklist-90-Revised (SCL-90-R) and the 16 Personality Factors Questionnaire (16PF). Then, skin conductance (SC), HR, and HRV, with frequency domain analysis (i.e., LF-HRV, HF-HRV, LF/HF ratio), were recorded at baseline and under induced stressors through a Psychophysiological Stress Profile (PPS). Following CCT, its efficacy was measured through a comparison of psychological symptoms (i.e., SCL-90-R) and baseline, reactivity, and recovery psychophysiological values (i.e., SC, HR, and HRV). Additionally, the coherence index (CI), corresponding to the cardiac coherence (CC) score, as well as its cumulative score, the achievement score (AS), were collected. Nonetheless, the percentage of CI (%INITIAL-CI) and AS (%INITIAL-AS) variation compared to the initial session was calculated.

Results: Lower levels of somatizations, depression, obsessions and compulsions, and hostility were observed, as well as lower reactivity to HR and better recovery of SC at T1. On the other hand, an increase in LF-HRV and a higher HRV (LF/HF ratio) in general were appreciated. Furthermore, the value of %INITIAL-CI of the last CCT session positively correlated with the post-stress recovery SC value at T0, as well as with some personality traits connected to self-regulation capability. Specifically, emotional stability positively correlated with %INITIAL-CI and %INITIAL-AS. Furthermore, the latter was also significantly associated with perseverance.

Conclusions: Although the absence of the control group should be noted as a limitation, the purpose is to emphasize the correlations between CI and AS at the end of the intervention and the psychophysiological and personality measures.

Objective: This narrative review examines clinical, genetic, and epidemiological evidence on schizophrenia (SCZ) to identify predictors of self-harm and violence, summarize genetic contributors to SCZ including pleiotropy and links between polygenic burden and negative/disorganized symptoms, and evaluate implications for early identification and predictive tools.

Method: We synthesized findings from large-scale genome-wide association studies, rare variant and polygenic risk research, gene-environment interplay, epidemiological studies on suicide and violence, and clinical trials of early-intervention programs for SCZ.

Results: SCZ involves a complex genetic architecture that includes hundreds of common risk variants and rarer coding and structural mutations. These genetic factors interact with environmental exposures, particularly childhood adversity and substance use, to shape vulnerability trajectories. Suicidality is a leading cause of excess mortality in SCZ, especially in early disease phases. Violence risk is modest overall but elevated in individuals with untreated psychosis or comorbid substance misuse. Emerging findings suggest that polygenic burden is linked to negative and disorganized symptoms, which in turn associate with worse clinical outcomes. Early, sustained, multicomponent intervention improves symptoms, functioning, and treatment adherence and may reduce self-harm and indirectly mitigate violence by addressing modifiable risk factors. Emerging machine learning models, though not yet widely validated, show promise in identifying individuals at higher risk of suicide or aggression by integrating clinical, demographic, and biological features.

Conclusions: Integrating genetic, clinical, and environmental data can enhance risk stratification and support precision prevention in SCZ. Polygenic risk scores are not yet clinically predictive alone but may add value when combined with symptom profiles and early-life adversity for early identification and detecting susceptibility to negative/disorganized symptoms. Near-term priorities include externally validating prediction tools, standardizing screening for trauma exposure and substance use within early-psychosis services to guide monitoring intensity and relapse-prevention planning, and scaling coordinated specialty care.

Recent developments in the study of highly visual social media have highlighted that, far from being neutral conduits, adolescents' online environments might be curated by recommender systems that learn from behaviour. On this view, risk and benefit may depend less on time spent online than on patterns of exposure ‒ what reaches young people, how they meet it, and when in development contact occurs. For instance, in large adolescent cohorts, only 10-15% of users account for most of the association between use and distress, underscoring the relevance of heterogeneity. Similar feeds might support connection and care while, in susceptible users, amplifying appearance-centred comparison, compulsive use and contact with harmful material. A public-health perspective treats personalisation as an upstream determinant and invites proportionate responsibilities, namely transparency, independent audit and safety-by-design. Clinically, brief assessments that separate time from type of engagement, paired with low-burden, mechanism-focused interventions, could offer practical steps. Taken together, a precautionary and balanced stance should aim at keeping what is valuable online while reducing foreseeable harm through accountable design.

Objective: Despite the increasing amount of data showing the presence of high association between gender dysphoria (GD) and autism spectrum disorders, less is known on the association between GD and other neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD). The aim of this study was to examine the prevalence and clinical features of ADHD in a group of adults with a primary diagnosis of GD.

Method: A sample of 81 consecutive adults newly diagnosed with GD were assessed using standardized self-report measures evaluating GD severity, mood and anxiety symptoms, and ADHD. GD participants with associated ADHD were compared to participants without ADHD regarding gender dysphoria symptoms, mood and anxiety symptoms, and functional impairment.

Results: We found a 33.3% prevalence of ADHD among GD individuals. Those with GD and ADHD had a significantly higher lifetime prevalence of psychiatric co-occurrence-particularly borderline personality disorder and cannabis use disorder- along with greater mood (U = 3.805, p < .001) and anxiety symptoms (U = 3.717, p < .001), and more severe functional impairment (U = -3.233, p = .001) compared with GD individuals without ADHD. No group differences emerged in GD symptom severity.

Conclusions: Findings indicate that GD individuals show high prevalence of ADHD and that individuals with both GD and ADHD appear to represent a more complex subpopulation with heightened depressive and anxiety symptoms and increased functional impairment. These results underscore that the presence of ADHD is frequent and appears to exert an important clinical impact on individuals with GD; therefore, ADHD should be routinely screened for in this population.

Objective: in the last decades, social networking sites (SNSs) use among adolescents has dramatically increased, feeding the adolescents' needs. However, younger users might be more vulnerable to problematic social networking. Scholar research increasingly highlighted the need to explore the underlying mechanisms of problematic use of SNSs. Difficulties in emotion regulation, general distress, experiences of shame, and specific motivations for SNSs use might represent risk factors for problematic social networking. On the contrary, other variables adolescence-related and potentially involved in problematic SNSs use (emptiness, boredom, emotional autonomy, and self-concept clarity) need further exploration.

Method: the present person-centered study aimed at profiling SNSs teen users (13-19 years) based on their (problematic) social networking, by comparing their SNSs-related behaviors and motivations, emotional dysregulation, distress symptoms, emptiness, boredom, shame, self-concept clarity, and emotional autonomy.

Results: the study involved 774 Italian adolescents (57% females; mean age = 15.74 ± 1.62 years) and four different profiles characterized by unique patterns of (problematic) social networking were identified through the latent profile analysis (LPA): (1) non-problematic SNSs users, (2) at-risk SNSs users, (3) problematic SNSs users, and (4) defended SNSs users (ntp=218; AIC=39125.44; BIC=39988.37; SSABIC=39296.00; entropy=.97; LMP-LRT p <.05; BLRT p <.05).

Conclusions: concerning the emerging profiles, problematic and non-problematic SNSs users displayed the highest and lower levels of risk factors related to social networking, respectively. The so-called "Defended" profile might include participant adolescents who defensively avoided thinking about the psychological and emotional experiences of SNSs use, showing very low levels in all the variables exploring SNSs-related behaviors and motivations, and psychological risk.

Difficult-to-treat depression (DTD) extends beyond pharmacological non-response to encompass persistent symptoms, disability, and functional impairment despite optimal therapeutic strategies. This opinion advances a paradigm-shifting thesis: a biologically distinct inflammatory endotype exists within DTD, characterized by low-grade systemic inflammation (hs-CRP ≥3 mg/L), where treatment failure reflects a fundamental mechanistic mismatch between the pathogenic driver (neuroinflammation) and conventional monoaminergic interventions. We propose a precision stratification workflow: screen with hs-CRP, confirm and phenotype using a parsimonious cytokine panel (IL-6, TNF-α, IL-1β), and align interventions to underlying biology. Therapeutic options include targeted anti-inflammatory agents, neuromodulation, psychotherapy, lifestyle modifications, and digital monitoring. Assessment should prioritize patient-centered outcomes: functioning, quality of life, and cognition alongside symptom reduction. We outline pragmatic implementation within phased-care and public health systems, emphasizing equitable biomarker access and biomarker-enriched clinical trials. Reframing DTD through neuroinflammation transforms clinical heterogeneity from an obstacle into an opportunity: biomarker-guided precision care that matches mechanism to intervention, improving outcomes for patients whose depression has proven refractory to standard approaches.

Objective: elevated levels of pro-inflammatory cytokines are frequently observed in mood disorders, but their relationship with psychosomatic symptomatology remains underexplored. This study aimed to examine whether interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are associated with psychosomatic syndromes in patients with major depression (MD) and bipolar depression (BD), and whether these associations are moderated by sex.

Method: seventy-seven outpatients with MD or BD were assessed using the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) and the Patient Health Questionnaire-15 (PHQ-15) to evaluate psychosomatic symptoms. Depression and mania severity were measured with the Beck Depression Inventory-II (BDI-II) and the Mania Rating Scale (MRS). Circulating levels of IL-6 and TNF-α were analyzed. Associations were tested using multivariate regression and mediation analyses, controlling for demographic and health-related variables.

Results: both IL-6 and TNF-α were significantly associated with psychosomatic syndromes (as per DCPR-R) and PHQ-15 scores. IL-6, in particular, showed a strong association with persistent somatization (PS). These relationships remained significant after adjusting for affective-cognitive depressive symptoms and potential confounders. No significant moderating effect of sex was identified. Mediation analyses suggested that psychosomatic syndromes mediate the relationship between inflammatory cytokines and depressive symptomatology.

Conclusions: findings suggest that the link between inflammation and mood disorders is more closely related to psychosomatic syndromes than to mood symptoms alone. Elevated IL-6 levels may reflect somatization processes within depression rather than being directly pro-depressive. Psychosomatic syndromes may thus represent a key clinical and therapeutic target in mood disorders with elevated inflammation.