Acta Neuropsychiatrica最新文献

Objective: To investigate the effect of physical exercise intensity on state anxiety symptoms and affective responses.

Methods: Twenty-one healthy women (mean age: 23.6 ± 5.4 years) participated in three sessions: self-selected intensity exercise, moderate-intensity prescribed exercise, and a nonexercise control session. Before each session, participants were exposed to unpleasant stimuli. State anxiety symptoms and affective responses were assessed pre- and post-stimulus exposure and pre- and post-sessions. A two-way repeated measures ANOVA tested state anxiety, while the Friedman test analysed affective responses.

Results: Time significantly affected state anxiety symptoms [F (2,0) = 25.977; P < 0.001; η² _p = 0.565]. Anxiety increased post-stimulus (P < 0.001) and decreased after all sessions. No significant differences were found between exercise and control conditions. Time also significantly influenced affective responses [χ² (8.0) = 62.953; P < 0.001; Kendall's W: 0.375]. Affective responses decreased post-stimulus (P = 0.029) and significantly increased after both exercise sessions (P < 0.001) but remained unchanged in the control session (P = 0.183).

Conclusions: Although state anxiety increased after unpleasant stimuli in all conditions, reductions following exercise sessions were comparable to the nonexercise session. However, both exercise sessions uniquely improved affective responses, highlighting their potential for emotional recovery after unpleasant stimuli.

Pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) involves central stimulants and non-stimulant drugs. Because treatment preferences may vary geographically, we hypothesize that prescription data can be estimated from publicly available sources. First, we explore the relevance of internet search trends as proxies for real-life drug prescription patterns. Second, we identify geographical variations in ADHD drug trends over time. Publicly available Google Trends data for five ADHD drugs were analysed for the years 2010–2023. Temporal and spatial patterns were compared within Scandinavia, and the preference for central stimulants over non-stimulant drugs was compared across 17 countries. We find that internet search trends correlate with ADHD drug prescriptions. In the Scandinavian countries, a dominance of methylphenidate is observed, with rising internet search trends over time in Norway and Denmark. Furthermore, interest in lisdexamphetamine, relative to dextroamphetamine and atomoxetine, has increased sharply in recent years in the Scandinavian countries. The search proportion of central stimulants to non-stimulant drugs in Scandinavia ranges from 81% (Denmark) to 93% (Norway). Overall, internet search trends for ADHD drugs mirror reported prescription patterns and identify a dominance of methylphenidate, with an increasing interest in lisdexamphetamine. As such, search trends may serve as a feasible source for identifying geographical drug preferences.

Objective: This study aims to ascertain the effect of baseline IL-1Ra and IL-8 in the treatment response of patients with major depressive disorder (MDD) and to clarify the relationship between inflammation markers and depression.

Methods: We recruited 242 patients with a Beck Depression Inventory (BDI) score ≥ 17 referred to secondary care in Finland. The patients’ serum IL-1Ra and IL-8 concentrations were measured at baseline. Montgomery-Åsberg Depression Rating Scale (MADRS) tests and Alcohol Use Disorders Identification Tests (AUDIT) were administered at baseline and six weeks. The antidepressant treatments varied: somewere started, others changed or continued their previous medication, and others had their doses adjusted. Patients started behavioral activation therapy. Linear regression was used with a relative MADRS score change during six weeks as the dependent variable and patient age, AUDIT score, BMI, daily number of cigarettes smoked, sex, and serum IL-1Ra and IL-8 concentrations as independent variables.

Results: Higher baseline serum IL-1Ra and IL-8 levels were associated with a smaller relative change in the MADRS-score within the first six weeks of treatment in linear regression analysis (p < 0.001 and p = 0.007, respectively). In further analysis comparing groups with ≤ 24 and>24 MADRS score only the ≤ 24 MADRS score group showed a similar association.

Conclusion: Higher baseline IL-1Ra and IL-8 concentrations were associated with a lesser relative response to depression treatment, particularly in patients with mild depression. Results on IL-8 concur with earlier findings, whereas the association between higher IL-1Ra serum concentrations reduced treatment response is a novel finding.

Background: Although social anxiety remains prevalent, conventional exposure therapy faces limitations such as limited accessibility, high cost, and low ecological validity. These barriers highlight the need for alternative, scalable methods that can effectively simulate social evaluative contexts.

Objective: This study aims to evaluate the anxiety-inducing effects of videoconferencing exposure, measured through heart rate variability (HRV), using a fully online-based methodology.

Methods: A total of 31 participants who reported social anxiety were recruited online and engaged in a simulated videoconference task, where they interacted with multiple audience members' emotional faces on a 3 × 3 split screen. Their video recordings were analysed using imaging photoplethysmography to obtain HRV data. Baseline anxiety levels were assessed using validated self-report questionnaires, including the State Anxiety Scale (STAI-X1), Trait Anxiety Scale (STAI-X2), Social Interaction Anxiety Scale, and Social Phobia Scale.

Results: Pearson correlation analysis revealed that STAI-X1 scores negatively correlated with high-frequency normalised units (HFnu) changes and positively correlated with low-frequency high-frequency (LF-HF) ratio and low-frequency normalised units (LFnu) changes. Similar patterns were observed for STAI-X2. These findings suggest that higher levels of trait and state anxiety are associated with greater reductions in parasympathetic activity and increased sympathetic activation during online videoconferencing.

Conclusions: This study underscores the clinical potential of online videoconferencing as a scalable and accessible exposure therapy for the digital era, eliminating spatial and logistical constraints associated with traditional in-person exposure therapy.

Objective: The COVID-19 pandemic and associated restrictive measures affected the mental health and well-being of individuals globally. We assessed non-modifiable and modifiable factors associated with the change in well-being and mental health from before to during the COVID-19 pandemic in South Africa.

Methods: A cross-sectional online survey was conducted from 26 April, 2020, to 22 April, 2021. Paired samples t-tests were conducted to assess change in well-being (measured on The World Health Organization-Five Well-Being Index (WHO-5)) and mental health (a validated composite psychopathology p-score). Sociodemographic, environmental, clinical, and behavioural factors associated with change in outcomes were examined.

Results: The sample comprised of 1866 adults (M age = 44.26 ± 17.36 years, female = 78.9%). Results indicated a significant decrease in well-being (p < 0.001) and increase in p-score (p < 0.001) from before to during the pandemic. Having a prior mental health condition was associated with a worsening well-being score, while being female was associated with a worsening p-score. Being of Black African descent was associated with improved p-score and higher socio-economic status (SES) was associated with improved well-being. Factors associated with worsening of both well-being and the p-score included adulthood adversity, financial loss since COVID-19, and placing greater importance on direct contact/interactions and substance use as coping strategies. Higher education level and endorsing studying/learning something new as a very important coping strategy were associated with improved well-being and p-score.

Conclusion: Findings inform the need for targeted interventions to reduce and prevent adverse well-being and mental health outcomes during a pandemic, especially among vulnerable groups.

Objective: This study presents the most recent data on the incidence, prevalence, and years lived with disability (YLDs) due to anxiety disorders across the Middle East and North Africa (MENA) region from 1990-2021, analysed by sex, age, and sociodemographic index (SDI).

Methods: We reported the burden of anxiety disorders using data sourced from the Global Burden of Disease 2021 study. The estimates of prevalence, DALYs, and YLDs are provided as numbers and age-standardised rates, accompanied by their 95% uncertainty intervals (UIs).

Results: In 2021, the age-standardised point prevalence of anxiety disorders in the region was 5.95 thousand, with an incidence rate of 883.4 per 100,000. The number of YLDs in 2021 reached 4.5 million. From 1990 to 2021, the burden of anxiety disorders increased significantly. Lebanon had the highest burden in 2021. Among both sexes, the 10-14 age group had the highest incidence rate, while the 15-19 age group had the highest prevalence and YLD rates. In 2021, most age groups in the MENA region had YLD rates that were higher than the global average.

Conclusion: This study highlights the urgent need for a multidisciplinary approach to prevent and manage anxiety disorders. Ensuring accessible and affordable treatment options for all affected individuals is crucial. Governments should prioritise supporting programmes to effectively address mental health issues, given the unique socioeconomic and geopolitical challenges in the MENA region. By including effective preventive methods alongside treatment in healthcare strategies, the burden of anxiety disorders can be significantly reduced.

Background: Clozapine is the only licensed medication for treatment-resistant schizophrenia, although it is underused. Healthcare professionals (medical and non-medical professionals) play a crucial role in the management of clozapine. Consultant psychiatrists are accountable for the initiation of clozapine, whereas non-medical professionals are often responsible for the monitoring, the management of side effects and patient education. It appears that healthcare professionals‘ (HCPs) competence and confidence may have an effect on clozapine underutilisation.

Aim: To synthesise the most pertinent literature examining the factors influencing HCPs competence and confidence in the management of clozapine and how these factors influence variation in prescribing practice.

Methods: A review of the literature focusing on these elements was conducted. The Population, Context, Outcome (PCO) framework was adopted to support the literature search. The databases Medline, Psychinfo, Scopus, Cinahl, Pubmed, Embase, British Library, Ethos e-thesis, Google Scholar, Dart Europe e-thesis were consulted; the search was completed in January 2025. Screening, selection, data extraction and quality assessment were conducted independently by two researchers. Thematic analysis was used to investigate and compare the data emerging from the studies.

Results: Thirty-four articles were included in the review. Six themes were identified: attitude toward and knowledge about clozapine, misconceptions (regarding side effects, monitoring and co-morbidities), guidelines, education, training and experience. HCPs self-reported as competent with guidelines (local and national), yet they expressed less confidence in their ability to adhere to them and were uncertain about managing side effects. Lack of education, training and insufficient exposure to clozapine management were significant factors impacting competence and confidence, resulting in clozapine underuse and variance in prescribing practice. The review highlighted a gap in the literature, as only a few studies involving non-medical professionals were found.

Conclusions: A general lack of education and training related to clozapine use was identified amongst all professionals.The impact of educational programmes on improving competence and enhancing confidence was considered positive, however when integrated with clinical practice.The studies identified in this review were lacking in the involvement of non-medical professionals. Given their crucial role in managing side effects and educating patients and carers, it is evident that their inclusion in future research is imperative.

Objective: A previous analysis of 200,000 exome-sequenced UK Biobank participants using weighted burden analysis of rare, damaging variants failed to identify any genes associated with risk of affective disorder requiring specialist treatment. Exome-sequence data has now been made available for the remaining 270,000 participants and a two-stage process was applied in order to test for association in this second sample using only genes showing suggestive evidence for association in the first sample.

Methods: Cases were defined as participants who reported having seen a psychiatrist for 'nerves, anxiety, tension or depression'. Exhaustive testing of the first sample was carried out using rare variant analyses informed by 45 different predictors of impact of nonsynonymous variants. The 100 genes showing the strongest evidence for association were then analysed in the second sample using the same predictor as had been most statistically significant in the first sample.

Results: The results for the 100 nominated genes conformed closely with the null hypothesis, with none approaching statistical significance after correction for multiple testing.

Conclusion: Risk of common affective disorder, even if severe enough to warrant specialist referral, is not sufficiently impacted by effects of rare variants in a small enough number of genes that effects can be detected even with large sample sizes. Actionable results might be obtained with a more extreme phenotype but very significant resources would be required to achieve adequate power. This research has been conducted using the UK Biobank Resource.

Objective: Psychosocial wellbeing is increasingly recognised as a key outcome in dementia research and care, reflecting a shift towards person-centred care and patient-reported outcome measures. However, progress is hindered by a lack of a clear and consistent definition. The present systematic review aimed to establish how previous dementia research has defined the term and how existing definitions may be unified.

Methods: A systematic literature review was conducted in PubMed, Embase, and Web of Science using only the term 'psychosocial' as well as terms related to dementia in the search string. Two blinded reviewers independently conducted the abstract screening and full-text screening. Definitions used in included records were extracted and their content grouped into categories and domains. For papers presenting empirical findings, quality screening was performed using Critical Appraisal Skills Programme (CASP) checklists and findings were narratively summarised.

Results: A total of n = 36 records were identified that provided a definition for psychosocial wellbeing. Conceptualizations most commonly (86 %) included emotional wellbeing, social health (64%), behavioural symptoms (44%), and subjective lived wellbeing (42%). A total of n = 23 records also contained empirical data, which indicated that psychosocial wellbeing may be improved by several interventions such as tailored activities and validation group therapies, among others.

Discussion: The construct of 'psychosocial wellbeing' as currently used in dementia research predominantly incorporates emotional and subjective lived wellbeing, social health, and behavioural symptoms. This indicates an emerging consensus. To progress dementia research and care practice, it is essential that future studies use a common operationalisation.

Background: Depression is a complex mental health disorder with highly heterogeneous symptoms that vary significantly across individuals, influenced by various factors, including sex and regional contexts. Network analysis is an analytical method that provides a robust framework for evaluating the heterogeneity of depressive symptoms and identifying their potential clinical implications.

Objective: To investigate sex-specific differences in the network structures of depressive symptoms in Asian patients diagnosed with depressive disorders, using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3, which was conducted in 2023.

Methods: A network analysis of 10 depressive symptoms defined according to the National Institute for Health and Care Excellence guidelines was performed. The sex-specific differences in the network structures of the depressive symptoms were examined using the Network Comparison Test. Subgroup analysis of the sex-specific differences in the network structures was performed according to geographical region classifications, including East Asia, Southeast Asia, and South or West Asia.

Results: A total of 998 men and 1,915 women with depression were analysed in this study. The analyses showed that all 10 depressive symptoms were grouped into a single cluster. Low self-confidence and loss of interest emerged as the most central nodes for men and women, respectively. In addition, a significant difference in global strength invariance was observed between the networks. In the regional subgroup analysis, only East Asian men showed two distinct clustering patterns. In addition, significant differences in global strength and network structure were observed only between East Asian men and women.

Conclusion: The study highlights the sex-specific differences in depressive symptom networks across Asian countries. The results revealed that low self-confidence and loss of interest are the main symptoms of depression in Asian men and women, respectively. The network connections were more localised in men, whereas women showed a more diverse network. Among the Asian subgroups analysed, only East Asians exhibited significant differences in network structure. The considerable effects of neurovegetative symptoms in men may indicate potential neurobiological underpinnings of depression in the East Asian population.