Clinical Neuropsychiatry最新文献

Objective: Recent studies have pointed to neuroinflammation and neurotrophic factors as crucial mediators in the pathophysiology origins of mood disorders. The aim of this review is to assess the potential association between cognitive impairment, brain imaging abnormalities, and inflammatory biomarkers in patients affected by bipolar disorder (BD).

Method: Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines, we systematically searched PubMed, Google Scholar, Scopus, and Web of Science databases, with no year restriction, up until August 2023, for human studies that examined the relationship between inflammatory markers and cognitive impairment in BD patients. Studies based on neuroimaging, such as MRI, DTI, and fMRI, were also included, along with those examining the moderating role of specific inflammatory markers in the alteration of the brain.

Results: 59 human clinical studies satisfied the criteria for consideration. Most of the studies reviewed concur that inflammatory state, measured by peripheral blood levels of CRP and cytokines, constitutes an important contributor to cognitive impairment observed in patients with BD. Robust evidence indicates an association between cognitive impairment and CRP, IL-1RA, IL-6, and TNF-α with its receptors, whereas there is no convincing evidence for the involvement of other neuroinflammatory biomarkers. Neuroimaging studies suggest that brain structural/functional abnormalities seen in BD could also be linked to a neuroinflammatory condition.

Conclusions: Current data provide evidence of a link between cognitive impairments observed in BD patients and mechanisms of neuroinflammation. Emerging evidence indicates that systemic inflammation might also play an important role in the deterioration of brain structures critical to cognitive functions in patients with BD. The convergence of findings across these studies strengthens our understanding of the complex neurobiological underpinnings of these disorders. Identification of BD specific inflammatory markers may be of assistance for future early therapeutic interventions.

Objective: Rumination is conceptualized as a critical transdiagnostic vulnerability and maintenance factor for affective dysregulation and related emotional disorders. Recent research has pointed to transcranial direct current stimulation (tDCS) as a novel therapeutic tool for alleviating rumination, especially stress-induced rumination. However, the mechanisms of action underlying this effect remain unclear, particularly regarding the potential moderating role of executive control and trait-like rumination. Therefore, in this study, we investigated the impact of anodal tDCS on stress-induced rumination and the potential moderating influence of executive control and trait-like rumination on this efect.

Method: Forty participants from the general community (i.e., unselected sample) took part in a double-blind within-subjects design study wherein we compared anodal stimulation over the left dorsolateral prefrontal cortex(dlPFC) with a sham-stimulation procedure. Participants completed an N-back task, reflecting executive control, during tDCS stimulation, followed by a stress-induction protocol wherein we assessed stress-induced state rumination.

Results: We found no significant effect of tDCS on stress-induced state rumination and no modulation by executive control or trait rumination. Post-hoc Bayesian analyses corroborated these results and even supported the hypothesis that anodal tDCS does not impact stress-induced rumination.

Conclusions: From a clinical perspective, our results are at odds with the current outlook that tDCS is a viable tool for reducing rumination, particularly stress-induced rumination. However, we firmly believe that the results of null-finding studies, such as those from this study, are particularly valuable for future iterations and meta-researchon tDCS as a potential tool for targeting transdiagnostic processes, such as rumination. We also addressed methodological limitations and directions for future research in this area.

Objective: Recent evidence highlights that different agents may trigger immune-mediated processes involved in the pathophysiology of different neuropsychiatric conditions. Given the limited information on obsessive-compulsive disorder (OCD), the present study aimed at assessing current/past infections and plasma levels of vitamin D, vitamin B12, folic acid, homocysteine and common peripheral inflammatory markers in a group of OCD outpatients.

Method: The sample included 217 adult outpatients with an OCD diagnosis according to the DSM-5 criteria. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess the clinical phenotype and symptom severity. Laboratory blood tests measured levels of vitamin D, vitamin B12, folic acid, homocysteine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count and antibodies titers for cytomegalovirus (CMV), Epstein Barr virus (EBV), Toxoplasma gondii and antistreptolysin titer.

Results: Sixty-one patients had a previous EBV infection, 46 were seropositive for CMV IgG, 24 showed positive antistreptolysin titer, 14 were seropositive for Toxoplasma gondii IgG, and four for CMV IgM. More than a half of patients showed vitamin D insufficiency. Compared to seronegative patients, patients with a past EBV infection displayed significantly higher scores on the Y-BOCS total score and compulsion subscale, and other symptoms. Vitamin D was negatively correlated with both the Y-BOCS total score and the subscales scores. Folic acid was negatively correlated with the Y-BOCS total and obsessions subscale score.

Conclusions: The findings of our study show an association between Epstein-Barr infection and hypovitaminosis D and the overall severity and specific symptom patterns of OCD. The laboratory measures used in this study are useful, cheap and easy parameters that should be routinely assessed in patients with OCD. Further studies are needed to clarify their role in OCD pathophysiology and outcomes, as well as the potential therapeutic impact of vitamins and antibiotics/immunomodulatory agents in OCD and other psychiatric conditions.

Objective: Children with Attention Deficit Hyperactivity Disorder (ADHD) are often referred to Equine-Assisted Services (EAS) for therapy despite lack of validated protocols in the field. This paper reports the development and validation of ASTride (ADHD Skills Therapy): a protocol of Equine-Assisted Occupational Therapy (EAOT) intervention for children aged 6-12 with ADHD. The intervention addresses deficits in cognitive-emotional functions and participation.

Method: Phase one of the intervention development includes theoretical framework and core content based on an in-depth review of existing literature. Subsequently, the intervention protocol was revised by a panel of experts. Phase two includes a pilot study, during which five children diagnosed with ADHD (mean age= 10.40 year, SD 2.966) participated in a 12-week EAOT intervention according to the suggested protocol, with pre- and post-assessments conducted.

Results: Statistically significant improvements were found in executive functions, as reflected in the Behavioral Regulation Index (BRI) total score. Additionally, hope perception and everyday performance improved following the intervention.

Conclusions: Results support the feasibility of ASTride intervention protocol for the improvement of cognitive and emotional functions as well as everyday performance.

Objective: Metacognition has been conceptualized as the ability to reflect on self and others' mental states and representations, including affects, beliefs, and intentions. The Metacognition Self-Assessment Scale (MSAS) was developed to assess various aspects of metacognition, aiming to leverage its potential applications in fields like clinical psychology and psychotherapy. However, a concern associated with MSAS is whether individuals can accurately self-report difficulties in identifying and describing mental states, both their own and others', when they lack these abilities. In response to this challenge, we aimed to develop and validate an alternative reporting tool, the Metacognition Brief Rating Scale (MBRS), which serves as an informant form of MSAS.

Method: The MBRS was administered to 384 individuals randomly recruited from the general population. We employed a methodological strategy based on three successive steps. In the preliminary step, items from the MSAS were rewritten into a third-person version by the authors. In the second step, we examined whether the four-factor structure was congruent between the informant-report (MBRS) and the self-report (MSAS) using exploratory and confirmatory factor analysis. In the last step, we examined and compared the psychometric properties of the MBRS and MSAS items, including item characteristics and internal reliability analyses.

Results: The psychometric properties (items and scales) of both versions were found to be adequate, and the four-factor structure of the MBRS was supported. The correlation between the two versions was statistically significant, and the factor structures were similar.

Conclusions: The results support the psychometric properties of the MBRS. However, further research is needed, especially in larger non-clinical and clinical samples, to replicate and extend these findings.

Objective: The COVID-19 pandemic has imposed numerous challenges on the mental health of the population of each affected country. The mental health of patients hospitalized due to COVID-19 was particularly at risk. The goal of this research was to examine the occurrence of mental disorders in such patients and what were the risk factors for poorer mental health during hospital treatment for COVID-19.

Method: We included 135 subjects treated for COVID-19 who were discharged during January 2022. We collected their sociodemographic data as well as data on somatic comorbidities and treatment during hospitalization. We monitored how many patients were hospitalized with a psychiatric diagnosis and therapy, and how many of them started using psychotropic drugs during hospitalization. Those data were recorded both at the time of discharge and again one year later.

Results: Statistical analysis showed that the number of patients using psychotropic drugs increased 4x (n=11 (8.1%) at admission vs. n=44 (32.6%) in hospital) during hospital treatment due to COVID-19. There was an increase in the use of all psychotropic drugs except for antidepressants; specifically, there was a 3.3x increase in treatment with anxiolytics (5.2% at admission vs. 17.0% in hospital), a 3.4x increase in treatment with antipsychotics (5.2% vs. 17.8%), and an 8x increase in treatment with hypnotics (0.7% vs. 5.9%). Their use decreased close to baseline after discharge.

Conclusions: Our research showed that hospitalization due to COVID-19 leads to deterioration of mental health. We assume that there is a fear of death in the background, which can be well explained by the "landscape of fear" theory.