Journal of Psychiatry & Neuroscience最新文献

Background: Despite the effectiveness of specialized therapies, people with borderline personality disorder (BPD) continue to face substantial psychosocial challenges, which may be partially attributed to neuropsychological deficits arising from imbalances in the corticolimbic system. Transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (DLPFC) could enhance impulse control, emotional regulation, and cognitive functions; thus, we sought to explore the effectiveness of tDCS combined with online cognitive training on cognitive functions, BPD symptoms, and psychosocial functioning among patients with BPD.

Methods: This open-label study recruited adults with BPD who were not undergoing psychotherapy. Participants completed informational psychoeducation sessions, followed by 10 daily sessions of 20-minute tDCS over 2 weeks. Stimulation involved a continuous 2-mA current with the anode over the left DLPFC and the cathode over the right DLPFC. During each session, participants simultaneously engaged in online cognitive training using the Lumosity app (aspredicted.org no. 206 001).

Results: We included 29 participants. We noted significant improvements in cognitive functions, including the Towers of London task (Cohen d = -0.38 to -0.78), the Corsi Block-Tapping direct and total scores (d = -0.41 and -0.42, respectively), and the Stroop Interference and Alternance tests (d = 0.80 and 0.94, respectively). Emotional dysregulation showed a substantial reduction (d = 0.44), while impulsivity did not change significantly. Symptoms of BPD decreased (d = 0.69), while general functioning (d = 0.33) and the internal component of BPD functioning improved (d = -0.51).

Limitations: Although these preliminary findings are encouraging, further controlled studies are necessary to validate the efficacy and long-term effect of the intervention.

Conclusion: This combined approach appears to be well tolerated and produced promising short-term improvements in cognitive performance, BPD symptoms, and overall functioning. The results underscore the relevance of the left DLPFC in developing neuropsychologically integrative interventions for BPD.

Background: Intrauterine exposure of the developing fetus or neonate to bendodiazepine may lead to fetal abnormalities or adverse reactions. We sought to investigate whether benzodiazepine use before or during different trimesters of pregnancy had different associations with incident preterm births (PTB) or small for gestational age (SGA) infants.

Methods: We conducted a 13-year longitudinal cohort study incorporating population-wide, sibling, and paternal comparisons. We used nation-wide population-based data on diagnoses and drug prescriptions from the Taiwan National Health Insurance Research Database, with linkages to the Taiwan Birth Certificate Registration and the Taiwan Maternal and Child Health Database between 2004 and 2016. We obtained data on live births to mothers exposed or unexposed to benzodiazepine. Children born by the same mother without benzodiazepine exposures before or during pregnancy were ascertained to create the sibling comparison cohort. We also gathered information on newborns with benzodiazepine-exposed or unexposed fathers. We determined the risks of subsequent PTB and SGA during the 13-year follow-up period.

Results: We included data on 2 572 125 births to mothers exposed to benzodiazepine and 2 265 685 births to mothers unexposed to benzodiazepine. After adjustments and from our sibling comparison group, the increased risks of preterm births (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.53-1.91) and SGA (OR 1.47, 95% CI 1.14-1.89) were significant only among children born from mothers exposed to benzodiazepine in the third trimester.

Limitations: Our results are subject to unmeasured confounding factors, such as smoking and the severity of parental mental illness, which were not available in the administrative claims data.

Conclusion: Benzodiazepine exposure during the third trimester, but not the first or second trimesters, increased the risks of PTB and SGA. This result may reflect the direct effects of benzodiazepine on fetal development or the intrauterine environment.

Background: Although the processes underlying the relationship between developmental trauma and psychosis remain to be elucidated, alterations in hippocampal-dependent memory (HDM) processing may underlie this relationship. We hypothesized that exposure to developmental trauma would be negatively associated with HDM and hippocampal volume and positively associated with intrusive memories among people with psychosis.

Methods: We conducted a systematic search of studies published from Dec. 18, 2020, to Nov. 14, 2023, using the search terms "childhood," "trauma," "psychosis," and "memory processing" in Embase, PsycINFO, MEDLINE, OpenGrey, Google Scholar, and PTSDpubs. We conducted meta-analyses of studies that measured developmental trauma (self-report questionnaires or interviews), HDM (episodic memory performance and trauma-memory intrusions), semantic and recognition-memory performance, and hippocampal volume among people with psychosis. Subsample analysis determined whether these associations differed across the psychosis spectrum or for specific abuse types.

Results: We included 26 studies. Meta-analyses found that developmental trauma was not associated with total hippocampal volume (n = 4, outcomes = 6, d = -0.12, standard error [SE] = 0.20, p = 0.2), episodic memory performance (n = 10, outcomes = 42, d = 0.11, SE = 0.19, p = 0.5), recognition (n = 3, outcomes = 4, d = -0.55, SE = 0.58, p = 0.3), or semantic memory performance (n = 4, outcomes = 6, d = 0.08, SE = 0.13, p = 0.6) in participants across the psychosis spectrum. One study found that developmental trauma was associated with impaired episodic memory performance in participants with schizotypal disorder and participants with a mixed phenotype of affective and psychotic symptoms. Two studies found developmental trauma to be associated with increased involuntary memory intrusions in a sample of people with psychosis.

Limitations: We did not control for age of trauma, sex, or chronicity of trauma. Results should be considered with caution, given the high publication bias and study heterogeneity seen within meta-analyses.

Conclusion: The association between developmental trauma and memory processing may not affect HDM more than the psychotic symptoms already experienced by affected individuals. However, future studies should focus on the effects of developmental trauma on involuntary memory among people with psychosis.

Background: A history of trauma increases risk for excessive and problematic cannabis use, and this relationship may involve conditioned cannabis craving to trauma cues arising through classical and operant conditioning. Alterations in functional connectivity (FC) after trauma reminders within or between brain regions associated with reward processing may potentiate this link; however, the underlying neural mechanisms remain unstudied.

Methods: We recruited cannabis users with trauma histories from February 2021 to August 2022. Participants completed a semi-structured interview about a personally relevant traumatic experience, a typical cannabis use situation unrelated to trauma or stress, and an emotionally neutral situation, with responses informing development of 3-minute audiovisual cues. Using a randomized cross-over design, we presented personalized audio recordings and images of the neutral, cannabis-related, and trauma-related situations to participants in counterbalanced order using a cue reactivity paradigm adapted for the magnetic resonance imaging (MRI) environment. Participants self-reported on subjective cannabis craving and positive and negative affect after each cue presentation. We measured FC between striatal, cortical, and limbic regions via functional MRI during each cue.

Results: We included 27 cannabis users with trauma histories (74.1% female, average age 32.2 years, standard deviation 10.5 years). Trauma cues increased cannabis craving and negative affect and decreased positive affect relative to other cues. Cannabis cues increased craving relative to neutral and baseline cues. Trauma cues increased FC within the striatum and between striatal-cortical regions relative to neutral cues and increased striatocortical FC relative to cannabis cues. Cannabis cues increased cortical and corticolimbic FC relative to trauma cues and increased striatocortical FC relative to neutral cues.

Limitations: The sample was small in size and not formed exclusively of participants with diagnoses of posttraumatic stress disorder or cannabis use disorder.

Conclusion: Findings suggested potential neural mechanisms underlying the link between trauma and cannabis use. Trauma- and cannabis-related cues may potentiate cannabis craving through altered reward circuit FC.

Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often show cognitive deficits. Given that some evidence has suggested transcranial direct current stimulation (tDCS) as a potential alternative or adjunct to psychostimulants, we sought to perform a meta-analysis and systematic review to evaluate the effects of tDCS on clinical symptoms and cognitive function among children and adolescents with ADHD, as well as to summarize associated adverse effects.

Methods: We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up to May 7, 2025 for randomized controlled trials (RCTs) involving children and adolescents with ADHD who underwent tDCs therapy. The outcome included specific cognitive function assessments and clinical symptoms.

Results: We included 18 RCTs that involved 496 children and adolescents with ADHD, of which 14 trials (n = 388) were included in the meta-analysis. The results indicated that there was no significant improvement in clinical symptoms (standardized mean difference [SMD] 0.012, 95% confidence interval [CI] -0.235 to 0.259) and processing speed (SMD 0.063, 95% CI -0.145 to 0.27) compared with controls. For cognitive function, those who underwent tDCS showed significant improvement effects in attention (SMD 0.207, 95% CI 0.011 to 0.403) and inhibitory control (SMD 0.222, 95% CI 0.045 to 0.399). Subgroup analyses revealed that stimulation at the F3 site was more effective in improving attention, inhibitory control, and processing speed. A current intensity of 1 mA outperformed currents of 1.5 mA and 2 mA in enhancing inhibitory control, and the cathode was more effective than the anode. A single stimulation session appeared effective in improving attention and inhibitory control, although further studies are needed to confirm these findings.

Limitations: Some subgroup analyses included few studies, lacked ADHD subtype delineation, and involved only single-dimensional analysis, which limited comprehensive conclusions.

Conclusion: Overall, tDCS may improve the attention and inhibitory abilities of children and adolescents with ADHD, particularly with optimal stimulation parameters (F3 site, a current intensity of 1 mA, cathodal stimulation, and single-session stimulation). These findings suggest therapeutic potential but require larger clinical validation.