Journal of Clinical Psychiatry最新文献

Objective: Veteran status and bipolar disorder (BD) are two substantial risk factors for suicide. Models of suicide implicate neurocognition and impulsivity in suicidal behavior. We aim to examine neurocognitive dysfunction and impulsivity correlates of suicide in veterans with BD.

Methods: We included 29 veterans with a DSM-5 bipolar spectrum disorder with a suicide attempt history (BD/SA+), 33 veterans with bipolar spectrum disorder without a suicide attempt history (BD/SA-), and 22 healthy control veterans (HC) recruited between January 2021 and July 2023. Participants were administered the MATRICS Consensus Cognitive Battery; Barratt Impulsivity Scale; Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale; and Impulsive/Premeditated Aggression Scale.

Results: BD/SA+ performed worse on working memory than BD/SA-; mean difference (MD [95% CI], -5.74 [-10.65 to -0.82], P=.034) and HC (-10.31 [-15.77 to -4.85], P < .001). BD/SA+ also performed worse on verbal learning than BD/SA- (MD [95% CI], -4.49 [-8.41 to -0.57], P = .038) and HC (-5.52 [-9.87 to -1.16], P = .038). Differences between BD/SA+ and BD/SA- in working memory remained significant when adjusting for depressive (P = .037) and manic (P = .024) symptoms, but verbal learning was no longer significantly different when adjusted for depression. BD/SA+ also had higher scores than BD/SA- on impulsive (MD [95% CI], 3.68 [0.64 to 6.73], P = .018) and premeditated (5.80 [1.51 to 10.10], P = .013) aggression. Across the BD groups, poorer working memory was associated with greater premeditated aggression (r = -0.321, P = .013) while poorer verbal learning was associated with greater impulsive (r = -0.297, P = .021) and premeditated (r = -0.372, P = .003) aggression.

Conclusion: Results suggest that in veterans with BD, poorer working memory is associated with suicide attempt independent of depression, while verbal learning impairments associated with suicide attempt may be influenced by depression. Neurocognitive dysfunction may underlie aggression to drive suicidal behavior. Findings support the role of neurocognition in models of suicide in BD and can inform risk detection and intervention.

Objective: Brief social contact-based video interventions are effective in decreasing self-stigma and increasing treatment-seeking intentions. The present study is the first to target essential workers with self-reported anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms during the COVID-19 pandemic. We hypothesized that viewers of the intervention would show greater increases in treatment-seeking intentions than nonviewers and that those without prior mental health diagnoses or care would have larger increases than those with past mental health care engagement. Additionally, participants who were more emotionally engaged with the intervention would experience greater treatment-seeking intention increases.

Methods: This randomized controlled trial recruited 1,309 essential workers via crowdsourcing who self-reported threshold levels of anxiety, depression, or PTSD symptoms to view either a brief social contact-based video intervention or a control video. Participants' treatment-seeking intentions were assessed using 3 items from the Attitudes Toward Seeking Professional Psychological Help-Short Form at baseline, immediately postintervention, and 30 days afterward.

Results: Generalized estimating equation (GEE) analyses revealed an immediate group-by-time effect of increased treatment-seeking intentions in the intervention group (P = .006, Cohen d = 0.22). Further GEE analyses revealed significant effects among individuals in the intervention group without prior psychiatric diagnoses (P < .001, Cohen d = 0.41), as compared to those with psychiatric diagnoses, and among those without prior treatment experience (P < .001, Cohen d = 0.40) compared to those who had. Participants who were more emotionally engaged experienced significantly greater increases in treatment-seeking intentions (P < .001).

Conclusion: All hypotheses were supported, indicating the efficacy of a brief video intervention in increasing treatment-seeking intentions among essential workers with clinical needs. These results highlight the ability of brief, easily disseminated interventions to reach those most in need of care and effectively increase treatment-seeking intentions.

Trial Registration: Trial identifier: NCT05826132.

Objective: Lurasidone, a second-generation atypical antipsychotic, lacks significant published data on its transfer into human milk during lactation. The objective of this study was to (1) quantify the transfer of lurasidone into human milk, allowing for an estimation of maternal drug exposure to the breastfed infant and (2) report observations of infants exposed to lurasidone via breast milk.

Methods: Milk samples and health histories were collected from 9 lactating mothers who donated milk samples to the InfantRisk Human Milk Biorepository while taking lurasidone (20-80 mg/day) from 2022 to 2024. The drug concentration-time profile of lurasidone in milk was determined using liquid chromatography-mass spectrometry, and maternal lurasidone doses were standardized to 40 mg/day.

Results: Lurasidone had an average milk concentration of 39.5 ng/mL at the 40 mg/day standardized dose. The relative infant dose (RID) was 1.16%, which is below the standard 10% threshold for infant safety. Even using the highest observed individual concentration of 174 ng/mL, the calculated RID was 3.03%. There were no maternal reports of adverse effects in the infants exposed to varying degrees of lurasidone in milk.

Conclusion: The levels of lurasidone observed in all participants' milk samples were exceedingly low. The subsequently low RID is below the 10% threshold for infant safety, suggesting that the transfer of maternal lurasidone into human milk is clinically insignificant and poses minimal risk to a breastfed infant.

Objectives: This study aimed to assess the risk of dementia associated with specific autoimmune diseases and the impact of related pharmacologic treatments.

Methods: Patients 55 years or older diagnosed with dementia by neurologists or psychiatrists between 2010 and 2021 were identified using claims data from Taiwan's National Health Insurance program. We examined 22 autoimmune diseases for their associations with dementia, controlling for age, gender, urbanization level, and comorbidities.

Results: Dementia prevalence was higher among individuals with autoimmune diseases (10.5% in cases vs. 8.7% in comparisons). Thirteen autoimmune diseases were linked with an elevated dementia risk, particularly Behçet disease, multiple sclerosis, and systemic lupus erythematosus. Associations with vascular dementia were stronger than with Alzheimer disease. Although overall dementia risk was higher in women, no significant sex differences were observed for specific autoimmune diseases. Nonsteroidal anti-inflammatory drugs and corticosteroids did not significantly alter dementia risk among individuals with autoimmune diseases; however, immunosuppressants were associated with a reduced risk when used for more than 180 days.

Conclusions: Certain autoimmune diseases are significantly associated with an increased risk of dementia, particularly vascular dementia, highlighting the distinct role of inflammation. Effective prevention or treatment of autoimmune diseases may reduce dementia incidence by 0.8%. While immunosuppressants show potential for risk reduction, further prospective studies are needed to confirm this effect.

Objective: To assess determinants of immediate postpartum anxiety (IPPA) and its association with postpartum depression (PPD).

Methods: We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter, French cohort including 3,310 women enrolled between November 2011 and June 2016. Women completed the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) at the maternity department between the second and fifth days following childbirth. IPPA was defined by HAD-A score >7, while HAD-A score >10 defined moderate to severe IPPA. Risk factors were collected. PPD was assessed prospectively at 2 months and 1 year postpartum.

Results: The prevalence of IPPA in this population was 24%, and 7.4% for severe anxiety. Factors independently associated with IPPA were found. Among women with IPPA, 31.2% developed PPD, compared to 16.9% of those without anxiety (adjusted odds ratio [aOR]=2.0; [95% CI, 1.6-2.5]). The association was stronger for early-onset PPD (aOR=2.2 [1.7-3.0]) than for late-onset PPD (aOR=1.8 [1.3-2.4]), even after adjusting on sociodemographic characteristics and history of major depressive episode before or during pregnancy. The higher the intensity of IPPA was, the higher the prevalence of PPD was.

Conclusion: IPPA has specific determinants and is associated, according to its intensity, with early-and late-onset PPD. Identifying (1) women at risk of anxiety, and thus eligible for dedicated support during pregnancy, and (2) women exhibiting anxiety during their maternity stay represent two targets to prevent the onset of PPD.

Objective: This proof-of-concept study examined the effects of brexpiprazole treatment on substance use, psychiatric symptoms, and quality of life in patients with co-occurring schizophrenia and substance use disorder.

Methods: In this 12-week study, patients diagnosed with schizophrenia and substance use disorder using DSM-5 criteria were randomly assigned to switch from their current antipsychotic medication to brexpiprazole (up to 4 mg/day) or remain on their current antipsychotic treatment (treatment as usual [TAU]). Substance use was assessed by the number of days of substance use and the dollars spent on substance in the past week, and substance craving was assessed using the Visual Analog Scale (VAS). Quality of life was assessed using the Heinrichs-Carpenter Quality of Life Scale (QOL). In addition, psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity of Illness.

Results: Thirty-nine patients were randomized (21 in the brexpiprazole group, 18 in the TAU group). Mixed models for repeated measures showed that, despite the lack of statistical significance, a consistent pattern of decrease in the brexpiprazole group was observed for the number of days of substance use and the dollars spent, as well as substance craving; the brexpiprazole group had a 15.5 points greater decrease in VAS (P=.157) and a $33.3 greater decrease in the dollars spent (P=.108) from baseline to week 12 compared with the TAU group. The brexpiprazole group did show a statistically significant 8.9 points greater increase in QOL compared with the TAU group (P =.020). Even though it was not statistically significant, the brexpiprazole group had a 2.4-point greater decrease in the PANSS General Psychopathology subscale score (P=.150) and a 1.9-point greater decrease in the PANSS Negative Symptom subscale score (P=.126) compared with the TAU group.

Conclusion: This study suggests that brexpiprazole might be beneficial in reducing substance craving and use in patients with schizophrenia and co-occurring substance use disorder; this potential benefit may help improve quality of life and overall psychiatric symptoms in a difficult-to-treat patient population.

Trial Registration: ClinicalTrials.gov identifier: NCT03526354.

Objective: Estimate nationwide postpartum depression (PPD) at 2 months prevalence and its related risk factors.

Methods: The representative study sample comprised 7,133 women who were included in a national perinatal population- based survey of all women who gave birth in France in March 2021. Data on maternal characteristics, course of pregnancy/delivery, and child's health were collected from face-to-face interviews in maternity wards and/or medical records and a self-questionnaire (including the Edinburgh Postnatal Depression Scale [EPDS]) at 2 months postpartum. Women with an EPDS score ≥13 were considered to have PPD. Poisson regression models with robust variance were used to estimate adjusted prevalence ratios (aPRs) for PPD.

Results: PPD prevalence at 2 months was 16.7% (95% CI, [15.7-17.7]). Factors significantly associated with PPD were (1) age ≤29 or ≥40 years (maximum aPR=1.41 95% CI, [1.12-1.77] obtained for 15- to 24-year-olds vs 35- to 39-year-olds); (2) being born in North Africa (1.29 [1.02-1.64] vs France); (3) having a lower level of health literacy (1.23 [1.14-1.35]); (4) having a history of psychological (1.45 [1.24-1.69]) or psychiatric (1.52 [1.23-1.88]) care since adolescence (vs none); (5) receiving little/ no support or good support during pregnancy (1.80 [1.52-2.14] and 1.31 [1.15-1.48] vs receiving very good support); (6) reporting feelings of sadness (1.92 [1.65-2.25]), anhedonia (1.69 [1.36-2.11]), or both (2.61 [2.26-3.01]) during pregnancy (vs none of these feelings); and (7) having had an instrumental vaginal delivery (1.18 [1.01-1.38] vs spontaneous vaginal delivery).

Conclusion: These findings on PPD (prevalence and profile of women at higher risk) could guide clinicians and policies on early identification and preventive support for women in the perinatal period.

Iron is an essential trace element that is important for the development, structure, and functioning of the brain. Iron has been both favorably and unfavorably implicated in neuropsychiatric disorders. For example, iron adequacy in pregnancy and early childhood has been suggested to reduce the risk of neurodevelopmental disorders and schizophrenia, but iron mechanisms have been implicated in neurodegenerative disorders, multiple sclerosis, and stroke. Supplemental iron may be indicated to treat restless legs syndrome, akathisia, and pica, but more commonly to treat iron deficiency associated with poor nutrition in major mental illness. Supplemental iron is commonly orally administered but is poorly absorbed by this route. It is therefore necessary to know what improves and what impairs iron absorption. This article explains that, for best absorption, oral iron supplements are ideally dosed as ferrous salts. The dose should be administered in the morning, on a fasting stomach, along with about 100 mg of vitamin C in the form of a tablet, or with a glass of orange or other citrus juice. If neither vitamin C nor citrus juice is available, as a poorer option, iron should be dosed with plain water. Absorption is markedly reduced if iron is administered in the afternoon, or with food such as cereals and other grains, or with beverages such as milk, tea, and coffee. Calcium supplements, antacids, H2 inhibitors, and proton pump inhibitors also reduce the absorption of orally administered iron. Some data suggest that alternate day dosing improves fractional iron absorption as well as reduces adverse effects of treatment. Finally, to reduce the risk of pill esophagitis, iron should be dosed with a full glass of liquid, and the patient should not recline or lie down for at least the next 30-60 min.