Acta Neuropsychiatrica最新文献

Orexin, also called hypocretin, is a neuropeptide that acts on central nervous system receptors to promote arousal. Suvorexant, its receptor antagonist, generates interest as a medication to treat insomnia. Suvorexant helps in decreasing wakefulness by counteracting orexin activity. Its low side effect potential may offer considerable benefit. Compared with other sleep aids, diminished drowsiness and less cognitive dysfunction is an advantage. Now approved for clinical use, an apparent lack of rebound insomnia or drug dependence potential might make suvorexant a good choice pharmacotherapy for patients with insomnia.

Background: Autosomal recessive intellectual disability (ID) is genetically heterogeneous and most of the genes causing it remain undiscovered.

Objective: We have ascertained 11 consanguineous families multiplex for IDs in order to identify new loci for autosomal recessive genes for non-syndromic ID, or to aid pinpointing mutations in known causative gene/loci. Methodology Microarray genotyping (Affymatrix 250K) was performed to identify homozygosity-by-descent (HBD) in all affected families.

Results: Analysis of genotypes revealed 45 potential HBD regions across the families, although these may be rationalised down to 39. Two families share an overlapping HBD region on 7q11.21. In one family, X-linkage also looks plausible, and a new ID gene near the centromere may be a likely cause. In one family, no HBD region was found, and thus we exclude autosomal recessive mutation as the likely cause in this family. Copy-number variation (CNV) was also performed and revealed no CNVs, homozygous or heterozygous, segregating with the phenotype.

Conclusion: The homozygous loci identified in this study might harbour candidate genes for ID in these studied families. Therefore, we are proceeding with next-generation sequencing analysis of the families, using whole-exome approaches, and anticipate that this will identify the causative gene/mutation within the identified HBD regions for many of the families studied here.

Objective: In this study, we aimed to find out whether sexual dysfunction in patients with Parkinson's Disease (PD) was associated to PD-related disability and whether this relationship was modulated by depressive and anxiety symptoms.

Methods: Eighty-nine consecutive patients with idiopathic PD who attended to our movement disorders outpatient clinics between January 2011 and June 2014 were included in this study. The diagnosis of PD was confirmed by a movement disorders specialists in Neurology, according to UK Parkinson's Disease Society Brain Bank Criteria. The Unified PD Rating Scale (UPDRS) motor was used to assess motor disability and Hoehn and Yahr stage (H&Y) was used to establish disease severity. Cognitive function was assessed by the Mini-Mental State Examination. Patients were also administered the Hamilton depression (HAMD) and anxiety (HAMA) rating scales. The sexual functions of the patients were rated by applying the Turkish version of the Arizona Sexual Experiences Scale (ASEX).

Results: The mean age at the time of the study visit was 67.74±9.05. Male/female ratio was 1.87. Mean UPDRS total was 29.06±13.96 and mean UPDRS motor was 17.62±9.07. Mean HAMD score was 13.92±10.86, 58.4% of the patients had minor or major depression; and mean HAMA score was 7.94±6.49, 56.2% of the patients had minor or major anxiety. The mean ASEX score was 18.54±7.27 out of a maximum of 30. ASEX total scores were correlated with age, H&Y stage and HAMA scores. Age and also age at onset were correlated with ASEX subdomains except sexual desire. There was no correlation between disease duration and ASEX subdomains. UPDRS motor score was correlated with erection/lubrication. HAMD was only correlated with orgasm satisfaction. HAMA score was correlated with stimulation and orgasm.

Conclusion: In patients with PD, there may be a common factor that modulates both depression, anxiety and sexual function. Further studies are needed to clarify the exact relationship.

Objective: Brain-derived neurotrophic factor (BDNF) plays a critical role in brain plasticity processes and serum levels have been demonstrated to be altered in patients with different mental disorder including suicidal behaviour. The objective of this study was to examine the association between serum BDNF levels as a possible peripheral indicator of suicide behaviour in subjects suffering from depression, personality disorders (PDs) and adjustment disorders (ADs) with or without suicide attempt.

Methods: The research included 172 randomly selected individuals suffering from recurrent depressive disorder (RDD; F 33.2), emotionally unstable PD (F 60.3) and AD (F 43.2), with or without attempted suicide according to the criteria of the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) and 60 phenotypically health control subjects. In the group of patients, 73% subjects took some form of psychopharmacotherapy. Serum BDNF levels were measured by enzyme linked immunosorbent assay.

Results: Subjects with PD and AD with suicide attempts had significantly lower serum BDNF levels than those without suicide attempts. In groups of subjects with PD and AD, those taking psychopharmacotherapy had higher serum BDNF levels. In the group of subjects with RDD, there were no differences with respect to suicide attempts or psychopharmacotherapy. Logistical regression analysis was indicated that psychopharmacotherapy and serum BDNF levels statistically correlated with suicide attempts.

Conclusion: The lower levels of BDNF in subjects suffering from PD and AD with suicide attempts, suggest that the serum BDNF level is a potential marker of suicidal behaviour, independent of mental disorders.

Objective: Deep brain stimulation is currently an experimental treatment for major depressive disorder. Information is lacking, however, on how sham responding may affect efficacy. This article applies exploratory meta-analysis to address that topic.

Methods: Data on benefits of deep brain electrical stimulation come from a recent review. Stimulated brain regions included subgenual cingulate, capsular interna, nucleus accumbens, and medial forebrain bundle. Expert opinion plus random number software was used to generate hypothetical values for sham responding.

Results: An effect size of 1.71 (95% CI: 1.47-1.96) was obtained for deep brain stimulation versus sham treatment in patients suffering from long-term treatment-resistant depression.

Conclusion: Preliminary findings on deep brain electrical stimulation suggest that the procedure may be 71% more effective than sham treatment. Expressing these findings as patients-needed-to-treat, deep brain electrical stimulation is required by 2.9 patients with long-term treatment-resistant depression in order for one of them to benefit.

Background: Shared decision making (SDM) is an essential component of patient-centered care, but there is little information about its use in the psychiatric care.

Objective: To measure to what extent psychiatric patients feel they were involved in the process and steps of decision making about treatment choice and to analyse the influence of socio-demographic, clinical, and psychological processes on this perception.

Methods: Cross-sectional survey involving 1100 consecutive psychiatric outpatients invited to complete the nine-item Shared Decision-Making Questionnaire (SDM-Q-9), health locus of control and control preferences, self-efficacy and drug attitude scales, as well as a questionnaire including socio-demographic and clinical variables.

Results: A high response rate of 77% was registered, resulting in a sample of 846 psychiatric outpatients. SDM-Q-9 total score indicate a moderately low degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. Patient diagnosis evidenced significant differences in SDM perception. Patients' perception of SDM was explained by four main variables: the older the patient, the lower self-reported SDM; having a diagnosis of schizophrenia increases the likelihood of lower SDM; a positive attitude towards psychiatric drugs favors greater SDM, as well as a higher level of self-efficacy.

Conclusion: The result of this study suggests that SDM is currently not widely practiced in psychiatric care. Further research is needed to examine if the low level of participation self-reported is justified by psychiatric patients' decisional capacity.

Personalised medicine has finally been featured in psychiatric journals, but psychiatrists have mainly focused on the promise of using disease mechanisms to personalise treatment. Psychiatric disorders such as schizophrenia and depression are not diseases, in the medical sense, and are probably more like syndromes. Instead of spending much time and effort focusing on the mechanisms of diseases that may instead be syndromes, the author believes that psychiatrists should (1) learn more about personalising prescription via drug mechanisms, a pharmacological approach to personalised medicine; and (2) reconsider prior attempts by traditional clinical psychopharmacologists to use sophisticated clinical approaches that try to subdivide psychiatric syndromes into groups that may be more homogenous for treatment response.

Objective: The aim of this study was to evaluate the validity of a new apathy rating scale in predicting the ability to return to work (RTW) in patients with depression or anxiety a year after discharge from a psychiatric hospital.

Methods: We evaluated 56 patients with depression or anxiety, who participated in an on-going randomised clinical trial using RTW as primary outcome. The degree of apathy was measured by the Diagnostic Apathia Scale, which contains six items covering the following neuropsychological symptoms: concentration/memory problems, difficulties in decision making, lassitude, tiredness/fatigue, insomnia, and reduced ability to work and engage in personal interests. The scale was analysed for psychometric validity (scalability) and for its ability to predict RTW. Finally, the predictive validity of the Diagnostic Apathia Scale regarding RTW was compared with scales measuring severity of depression/anxiety symptoms, disability, and psychological well-being.

Results: The Diagnostic Apathia Scale displayed sufficient scalability, that is, the total score was a psychometrically valid measure of apathy. Only the Diagnostic Apathia Scale, and not the scales measuring severity of symptoms, disability, or psychological well-being, had predictive validity regarding RTW. Thus, 76% with 'clinically significant apathy' at baseline were unable to RTW versus 50% of the patients without apathy (p<0.05).

Conclusion: The Diagnostic Apathia Scale was found to have an acceptable predictive validity in terms of patients' ability to RTW 1 year after discharge from hospitalisation for depression or anxiety.